- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $882.48 / $4,085.00 / $9,863.00
| Facility | | $882.48 | $4,085.00 | $9,863.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,760.00 / $3,576.00 / $14,996.00
| Facility | | $1,760.00 | $3,576.00 | $14,996.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.17 / $599.58 / $796.32
| Facility | | $467.17 | $599.58 | $796.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,571.00 / $21,571.00 / $21,571.00
| Facility | | $21,571.00 | $21,571.00 | $21,571.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $599.27 / $1,436.97 / $6,006.00
| Facility | | $599.27 | $1,436.97 | $6,006.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $59.43 / $59.43 / $59.43
| Facility | AS | $59.43 | $59.43 | $59.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,840.00 / $5,625.00 / $7,847.00
| Facility | | $2,840.00 | $5,625.00 | $7,847.00 |