- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $894.03 / $2,993.02 / $18,730.18
| Facility | | $894.03 | $2,993.02 | $18,730.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,878.00 / $15,141.00 / $22,609.00
| Facility | | $10,878.00 | $15,141.00 | $22,609.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,127.54 / $2,486.19 / $4,010.16
| Facility | | $2,127.54 | $2,486.19 | $4,010.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $821.03 / $895.67 / $1,604.74
| Facility | | $821.03 | $895.67 | $1,604.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $894.03 / $8,791.00 / $17,200.00
| Facility | | $894.03 | $8,791.00 | $17,200.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $821.03 / $895.67 / $1,604.74
| Facility | | $821.03 | $895.67 | $1,604.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,623.70 / $2,498.00 / $2,953.39
| Professional | | $1,623.70 | $2,498.00 | $2,953.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27,770.10 / $27,770.10 / $27,770.10
| Facility | | $27,770.10 | $27,770.10 | $27,770.10 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $2,632.21 / $2,632.21 / $2,632.21
| Facility | AS | $2,632.21 | $2,632.21 | $2,632.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,627.00 / $13,752.00 / $17,450.00
| Facility | | $8,627.00 | $13,752.00 | $17,450.00 |