- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,408.26 / $4,048.00 / $10,099.52
| Facility | | $1,408.26 | $4,048.00 | $10,099.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,531.00 / $27,840.00 / $46,296.00
| Facility | | $13,531.00 | $27,840.00 | $46,296.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,567.52 / $1,567.52 / $1,567.52
| Facility | | $1,567.52 | $1,567.52 | $1,567.52 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $155.62 / $155.62 / $155.62
| Facility | AS | $155.62 | $155.62 | $155.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,250.66 / $13,432.13 / $25,147.15
| Facility | | $3,250.66 | $13,432.13 | $25,147.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,261.38 / $4,894.00 / $10,247.00
| Facility | | $1,261.38 | $4,894.00 | $10,247.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,567.52 / $1,567.52 / $1,567.52
| Facility | | $1,567.52 | $1,567.52 | $1,567.52 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $155.62 / $155.62 / $155.62
| Facility | AS | $155.62 | $155.62 | $155.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,346.45 / $1,346.45 / $1,709.38
| Facility | | $1,346.45 | $1,346.45 | $1,709.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,747.00 / $2,824.00 / $5,678.00
| Facility | | $1,747.00 | $2,824.00 | $5,678.00 |