- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $712.87 / $9,544.15 / $20,928.72
| Facility | | $712.87 | $9,544.15 | $20,928.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,860.00 / $10,338.04 / $19,997.13
| Facility | | $7,860.00 | $10,338.04 | $19,997.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,116.45 / $7,116.45 / $7,116.45
| Facility | | $7,116.45 | $7,116.45 | $7,116.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $712.87 / $1,247.52 / $9,496.00
| Facility | | $712.87 | $1,247.52 | $9,496.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $200.61 / $2,550.66 / $2,550.66
| Facility | AS | $200.61 | $2,550.66 | $2,550.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,285.00 / $1,846.14 / $9,449.62
| Facility | | $1,285.00 | $1,846.14 | $9,449.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,569.59 / $8,163.00 / $9,696.00
| Facility | | $5,569.59 | $8,163.00 | $9,696.00 |