- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $797.33 / $5,201.00 / $11,627.00
| Facility | | $797.33 | $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
- $490.68 / $535.28 / $779.45
| Facility | | $490.68 | $535.28 | $779.45 |
- 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
- $625.29 / $625.29 / $625.29
| Facility | | $625.29 | $625.29 | $625.29 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $62.19 / $62.19 / $62.19
| Facility | AS | $62.19 | $62.19 | $62.19 |
- 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 |