- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,456.00 / $8,021.54 / $21,926.06
| Facility | | $1,456.00 | $8,021.54 | $21,926.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,723.84 / $13,599.58 / $21,400.78
| Facility | | $8,723.84 | $13,599.58 | $21,400.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,321.00 / $2,321.00 / $2,321.00
| Facility | | $2,321.00 | $2,321.00 | $2,321.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $937.55 / $1,788.50 / $13,541.98
| Facility | | $937.55 | $1,788.50 | $13,541.98 |
- 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
- $1,851.00 / $6,871.00 / $13,541.98
| Facility | | $1,851.00 | $6,871.00 | $13,541.98 |