- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,576.18 / $8,545.00 / $11,627.00
| Facility | | $1,576.18 | $8,545.00 | $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
- $1,506.50 / $1,807.80 / $2,237.54
| Facility | | $1,506.50 | $1,807.80 | $2,237.54 |
- 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
- $176.72 / $176.72 / $176.72
| Facility | AS | $176.72 | $176.72 | $176.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $425.00 / $600.00 / $1,806.52
| Facility | | $425.00 | $600.00 | $1,806.52 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $176.72 / $176.72 / $176.72
| Facility | AS | $176.72 | $176.72 | $176.72 |
- 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 |