- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $980.63 / $4,525.00 / $10,517.90
| Facility | | $980.63 | $4,525.00 | $10,517.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,263.00 / $5,184.00 / $11,809.00
| Facility | | $3,263.00 | $5,184.00 | $11,809.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,090.24 / $1,090.24 / $6,213.00
| Facility | | $1,090.24 | $1,090.24 | $6,213.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.67 / $891.67 / $7,227.90
| Facility | | $891.67 | $891.67 | $7,227.90 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $87.17 / $87.17 / $87.17
| Facility | AS | $87.17 | $87.17 | $87.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $332.00 / $1,394.42 / $6,045.34
| Facility | | $332.00 | $1,394.42 | $6,045.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $555.00 / $891.67 / $74,999.25
| Facility | | $555.00 | $891.67 | $74,999.25 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $87.17 / $87.17 / $87.17
| Facility | AS | $87.17 | $87.17 | $87.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,264.00 / $5,248.00 / $11,176.00
| Facility | | $2,264.00 | $5,248.00 | $11,176.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $982.61 / $982.61 / $2,953.22
| Facility | | $982.61 | $982.61 | $2,953.22 |