- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $931.60 / $5,851.00 / $11,581.00
| Facility | | $931.60 | $5,851.00 | $11,581.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,777.00 / $6,934.00 / $30,285.00
| Facility | | $2,777.00 | $6,934.00 | $30,285.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $653.22 / $838.36 / $1,113.44
| Facility | | $653.22 | $838.36 | $1,113.44 |
- 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
- $835.85 / $835.85 / $835.85
| Facility | | $835.85 | $835.85 | $835.85 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $82.88 / $82.88 / $82.88
| Facility | AS | $82.88 | $82.88 | $82.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,227.00 / $9,067.00 / $14,156.00
| Facility | | $4,227.00 | $9,067.00 | $14,156.00 |