- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,526.55 / $5,154.18 / $11,627.00
| Facility | | $1,526.55 | $5,154.18 | $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
- $1,463.50 / $1,756.20 / $2,173.67
| Facility | | $1,463.50 | $1,756.20 | $2,173.67 |
- 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
- $171.20 / $171.20 / $171.20
| Facility | AS | $171.20 | $171.20 | $171.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $425.00 / $600.00 / $1,751.21
| Facility | | $425.00 | $600.00 | $1,751.21 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $171.20 / $171.20 / $171.20
| Facility | AS | $171.20 | $171.20 | $171.20 |
- 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 |