- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,517.36 / $1,517.36 / $4,828.00
| Facility | | $1,517.36 | $1,517.36 | $4,828.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,677.15 / $7,747.84 / $13,455.94
| Facility | | $3,677.15 | $7,747.84 | $13,455.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,670.38 / $5,207.74 / $12,527.92
| Facility | | $3,670.38 | $5,207.74 | $12,527.92 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $175.11 / $175.11 / $175.11
| Facility | AS | $175.11 | $175.11 | $175.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,336.71 / $4,761.12 / $9,864.50
| Facility | | $3,336.71 | $4,761.12 | $9,864.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,579.39 / $2,848.70 / $4,746.00
| Facility | | $1,579.39 | $2,848.70 | $4,746.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $392.34 / $392.34 / $392.34
| Facility | AS | $392.34 | $392.34 | $392.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,412.00 / $4,746.00 / $8,812.00
| Facility | | $2,412.00 | $4,746.00 | $8,812.00 |