- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,671.00 / $4,521.00 / $9,685.00
| Facility | | $1,671.00 | $4,521.00 | $9,685.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,660.00 / $6,198.03 / $10,860.55
| Facility | | $1,660.00 | $6,198.03 | $10,860.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,411.00 / $5,411.00 / $7,214.00
| Facility | | $5,411.00 | $5,411.00 | $7,214.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,222.15 / $1,520.48 / $3,031.23
| Facility | | $1,222.15 | $1,520.48 | $3,031.23 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $330.68 / $604.77 / $604.77
| Facility | AS | $330.68 | $604.77 | $604.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $175.00 / $2,572.00 / $14,572.00
| Facility | | $175.00 | $2,572.00 | $14,572.00 |