- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.83 / $8,324.40 / $16,467.00
| Facility | | $1,350.83 | $8,324.40 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,366.50 / $6,861.51 / $11,947.84
| Facility | | $3,366.50 | $6,861.51 | $11,947.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $890.00 / $1,341.75 / $5,740.31
| Facility | | $890.00 | $1,341.75 | $5,740.31 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $133.40 / $133.40 / $133.40
| Facility | AS | $133.40 | $133.40 | $133.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.00 / $1,510.00 / $2,582.06
| Facility | | $1,258.00 | $1,510.00 | $2,582.06 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $187.54 / $211.40 / $344.27
| Facility | AS | $187.54 | $211.40 | $344.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $12,456.00 / $19,591.00
| Facility | | $2,155.00 | $12,456.00 | $19,591.00 |