- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,067.67 / $3,111.85 / $8,271.00
| Facility | | $1,067.67 | $3,111.85 | $8,271.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,697.00 / $5,904.00 / $15,421.00
| Facility | | $1,697.00 | $5,904.00 | $15,421.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $276.92 / $2,632.21 / $2,632.21
| Facility | AS | $276.92 | $2,632.21 | $2,632.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,770.00 / $2,950.00 / $9,386.07
| Facility | | $1,770.00 | $2,950.00 | $9,386.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $714.00 / $1,909.00 / $6,679.00
| Facility | | $714.00 | $1,909.00 | $6,679.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,697.00 / $7,331.00 / $27,770.10
| Facility | | $1,697.00 | $7,331.00 | $27,770.10 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $276.92 / $2,632.21 / $2,632.21
| Facility | AS | $276.92 | $2,632.21 | $2,632.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,697.00 / $4,671.00 / $13,017.00
| Facility | | $1,697.00 | $4,671.00 | $13,017.00 |