- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $788.20 / $5,201.00 / $11,627.00
| Facility | | $788.20 | $5,201.00 | $11,627.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,315.00 / $16,655.00 / $29,882.70
| Facility | | $3,315.00 | $16,655.00 | $29,882.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $485.14 / $529.25 / $770.66
| Facility | | $485.14 | $529.25 | $770.66 |
- 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
- $620.10 / $620.10 / $620.10
| Facility | | $620.10 | $620.10 | $620.10 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $61.67 / $61.67 / $61.67
| Facility | AS | $61.67 | $61.67 | $61.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,070.00 / $8,440.00 / $13,382.00
| Facility | | $4,070.00 | $8,440.00 | $13,382.00 |