- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,241.22 / $9,544.15 / $20,928.72
| Facility | | $4,241.22 | $9,544.15 | $20,928.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,183.05 / $10,762.95 / $20,819.02
| Facility | | $8,183.05 | $10,762.95 | $20,819.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,881.80 / $14,881.80 / $14,881.80
| Facility | | $14,881.80 | $14,881.80 | $14,881.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $671.23 / $1,174.65 / $9,696.00
| Facility | | $671.23 | $1,174.65 | $9,696.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $189.15 / $5,333.89 / $5,333.89
| Facility | AS | $189.15 | $5,333.89 | $5,333.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,285.00 / $1,681.25 / $18,850.28
| Facility | | $1,285.00 | $1,681.25 | $18,850.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,777.00 / $8,220.00 / $9,696.00
| Facility | | $6,777.00 | $8,220.00 | $9,696.00 |