- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $822.47 / $5,936.10 / $11,627.00
| Facility | | $822.47 | $5,936.10 | $11,627.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,760.00 / $5,491.00 / $14,996.00
| Facility | | $1,760.00 | $5,491.00 | $14,996.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $443.12 / $568.72 / $755.33
| Facility | | $443.12 | $568.72 | $755.33 |
- 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
- $568.39 / $4,153.17 / $20,889.71
| Facility | | $568.39 | $4,153.17 | $20,889.71 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $56.48 / $56.48 / $56.48
| Facility | AS | $56.48 | $56.48 | $56.48 |
- 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 |