- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $815.70 / $2,678.00 / $7,602.00
| Facility | | $815.70 | $2,678.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,695.00 / $5,467.00 / $9,419.00
| Facility | | $2,695.00 | $5,467.00 | $9,419.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,282.00 / $12,282.00 / $12,282.00
| Facility | | $12,282.00 | $12,282.00 | $12,282.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,145.63 / $17,070.15 / $26,542.00
| Facility | | $5,145.63 | $17,070.15 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $192.71 / $1,618.01 / $1,618.01
| Facility | AS | $192.71 | $1,618.01 | $1,618.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,964.00 / $8,273.00 / $19,000.00
| Facility | | $3,964.00 | $8,273.00 | $19,000.00 |