- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,074.15 / $7,010.48 / $11,627.00
| Facility | | $2,074.15 | $7,010.48 | $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
- $1,982.24 / $2,378.69 / $2,944.14
| Facility | | $1,982.24 | $2,378.69 | $2,944.14 |
- 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
- $233.27 / $233.27 / $233.27
| Facility | AS | $233.27 | $233.27 | $233.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $425.00 / $600.00 / $2,376.52
| Facility | | $425.00 | $600.00 | $2,376.52 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $233.27 / $233.27 / $233.27
| Facility | AS | $233.27 | $233.27 | $233.27 |
- 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 |