- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $978.64 / $4,723.00 / $11,581.00
| Facility | | $978.64 | $4,723.00 | $11,581.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,777.00 / $6,932.00 / $30,285.00
| Facility | | $2,777.00 | $6,932.00 | $30,285.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $605.72 / $777.38 / $1,032.47
| Facility | | $605.72 | $777.38 | $1,032.47 |
- 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
- $777.08 / $777.08 / $777.08
| Facility | | $777.08 | $777.08 | $777.08 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $76.84 / $76.84 / $76.84
| Facility | AS | $76.84 | $76.84 | $76.84 |
- 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 |