- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,346.00 / $3,445.54 / $9,973.03
| Facility | | $1,346.00 | $3,445.54 | $9,973.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,271.71 / $17,815.62 / $28,366.81
| Facility | | $11,271.71 | $17,815.62 | $28,366.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,321.00 / $2,321.00 / $2,321.00
| Facility | | $2,321.00 | $2,321.00 | $2,321.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,030.00 / $1,859.79 / $6,272.82
| Facility | | $1,030.00 | $1,859.79 | $6,272.82 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $603.26 / $603.26 / $603.26
| Facility | AS | $603.26 | $603.26 | $603.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $350.00 / $1,760.00 / $6,155.68
| Facility | | $350.00 | $1,760.00 | $6,155.68 |