- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $4,365.16 / $12,589.25
| Facility | | $1,096.48 | $4,365.16 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,244.36 / $13,489.63 / $25,703.96
| Facility | | $7,244.36 | $13,489.63 | $25,703.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $14,791.08 / $14,791.08
| Facility | | $724.44 | $14,791.08 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,079.46 / $10,000.00 / $10,000.00
| Facility | | $7,079.46 | $10,000.00 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.95 / $12,589.25 / $27,542.29
| Facility | | $54.95 | $12,589.25 | $27,542.29 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $2,754.23 / $2,754.23 / $2,754.23
| Facility | AS | $2,754.23 | $2,754.23 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $1,995.26 / $8,709.64
| Facility | | $794.33 | $1,995.26 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $1,096.48 / $1,905.46
| Facility | | $724.44 | $1,096.48 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $8,709.64 / $17,782.79
| Facility | | $2,630.27 | $8,709.64 | $17,782.79 |