- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.80 / $2,795.00 / $11,581.00
| Facility | | $812.80 | $2,795.00 | $11,581.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $337.94 / $735.60 / $2,897.00
| Facility | | $337.94 | $735.60 | $2,897.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $673.96 / $735.23 / $1,070.58
| Facility | | $673.96 | $735.23 | $1,070.58 |
- 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
- $858.84 / $858.84 / $858.84
| Facility | | $858.84 | $858.84 | $858.84 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $84.30 / $84.30 / $84.30
| Facility | AS | $84.30 | $84.30 | $84.30 |
- 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 |