- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $701.20 / $3,325.00 / $10,268.00
| Facility | | $701.20 | $3,325.00 | $10,268.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,712.00 / $3,264.00 / $14,996.00
| Facility | | $1,712.00 | $3,264.00 | $14,996.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $432.61 / $555.22 / $687.20
| Facility | | $432.61 | $555.22 | $687.20 |
- 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
- $555.37 / $555.37 / $555.37
| Facility | | $555.37 | $555.37 | $555.37 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $55.10 / $55.10 / $55.10
| Facility | AS | $55.10 | $55.10 | $55.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,233.00 / $4,223.00 / $6,522.00
| Facility | | $2,233.00 | $4,223.00 | $6,522.00 |