- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $820.17 / $4,590.00 / $10,817.74
| Facility | | $820.17 | $4,590.00 | $10,817.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,760.00 / $3,576.00 / $14,996.00
| Facility | | $1,760.00 | $3,576.00 | $14,996.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.15 / $738.16 / $980.37
| Facility | | $575.15 | $738.16 | $980.37 |
- 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
- $737.28 / $737.28 / $737.28
| Facility | | $737.28 | $737.28 | $737.28 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $73.26 / $73.26 / $73.26
| Facility | AS | $73.26 | $73.26 | $73.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,840.00 / $5,625.00 / $7,847.00
| Facility | | $2,840.00 | $5,625.00 | $7,847.00 |