- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,663.03 / $6,004.85 / $16,467.00
| Facility | | $2,663.03 | $6,004.85 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $890.00 / $890.00 / $2,606.76
| Facility | | $890.00 | $890.00 | $2,606.76 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $257.88 / $257.88 / $257.88
| Facility | AS | $257.88 | $257.88 | $257.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.73 / $3,068.00 / $4,904.31
| Facility | | $2,454.73 | $3,068.00 | $4,904.31 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $376.23 / $429.52 / $658.74
| Facility | AS | $376.23 | $429.52 | $658.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,471.00 / $5,871.00 / $8,973.00
| Facility | | $1,471.00 | $5,871.00 | $8,973.00 |