- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,026.49 / $6,772.77 / $11,627.00
| Facility | | $2,026.49 | $6,772.77 | $11,627.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,785.00 / $8,239.18 / $15,310.83
| Facility | | $2,785.00 | $8,239.18 | $15,310.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,940.17 / $2,328.19 / $2,881.66
| Facility | | $1,940.17 | $2,328.19 | $2,881.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $425.00 / $1,200.00 / $21,571.00
| Facility | | $425.00 | $1,200.00 | $21,571.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $227.05 / $227.05 / $227.05
| Facility | AS | $227.05 | $227.05 | $227.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $425.00 / $600.00 / $2,318.78
| Facility | | $425.00 | $600.00 | $2,318.78 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $227.05 / $227.05 / $227.05
| Facility | AS | $227.05 | $227.05 | $227.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $650.00 / $2,883.00 / $6,111.00
| Facility | | $650.00 | $2,883.00 | $6,111.00 |