- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,201.71 / $1,201.71 / $7,859.00
| Facility | | $1,201.71 | $1,201.71 | $7,859.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,726.07 / $22,897.69 / $46,771.99
| Facility | | $2,726.07 | $22,897.69 | $46,771.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,912.73 / $4,132.75 / $9,941.87
| Facility | | $2,912.73 | $4,132.75 | $9,941.87 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $142.94 / $142.94 / $142.94
| Facility | AS | $142.94 | $142.94 | $142.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,647.94 / $3,778.32 / $7,828.25
| Facility | | $2,647.94 | $3,778.32 | $7,828.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,322.18 / $2,089.21 / $5,913.00
| Facility | | $1,322.18 | $2,089.21 | $5,913.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $310.70 / $310.70 / $310.70
| Facility | AS | $310.70 | $310.70 | $310.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,457.00 / $9,370.00 / $12,774.00
| Facility | | $5,457.00 | $9,370.00 | $12,774.00 |