- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,803.41 / $5,526.59 / $10,635.00
| Facility | | $1,803.41 | $5,526.59 | $10,635.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,501.00 / $13,621.30 / $25,522.00
| Facility | | $3,501.00 | $13,621.30 | $25,522.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,567.08 / $1,880.50 / $2,327.52
| Facility | | $1,567.08 | $1,880.50 | $2,327.52 |
- 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
- $184.06 / $184.06 / $184.06
| Facility | AS | $184.06 | $184.06 | $184.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $425.00 / $600.00 / $1,879.13
| Facility | | $425.00 | $600.00 | $1,879.13 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $184.06 / $184.06 / $184.06
| Facility | AS | $184.06 | $184.06 | $184.06 |
- 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 |