- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,257.92 / $4,048.00 / $8,451.00
| Facility | | $1,257.92 | $4,048.00 | $8,451.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,639.91 / $11,851.00 / $26,582.19
| Facility | | $8,639.91 | $11,851.00 | $26,582.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,403.28 / $1,403.28 / $1,403.28
| Facility | | $1,403.28 | $1,403.28 | $1,403.28 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $139.43 / $139.43 / $139.43
| Facility | AS | $139.43 | $139.43 | $139.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,131.70 / $10,690.91 / $13,182.66
| Facility | | $10,131.70 | $10,690.91 | $13,182.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,127.40 / $4,761.00 / $9,617.00
| Facility | | $1,127.40 | $4,761.00 | $9,617.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,403.28 / $1,403.28 / $1,403.28
| Facility | | $1,403.28 | $1,403.28 | $1,403.28 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $139.43 / $139.43 / $139.43
| Facility | AS | $139.43 | $139.43 | $139.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,204.78 / $1,204.78 / $1,548.44
| Facility | | $1,204.78 | $1,204.78 | $1,548.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,468.00 / $4,563.00 / $7,000.00
| Facility | | $2,468.00 | $4,563.00 | $7,000.00 |