- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $706.09 / $5,201.00 / $11,627.00
| Facility | | $706.09 | $5,201.00 | $11,627.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,712.00 / $3,405.00 / $14,996.00
| Facility | | $1,712.00 | $3,405.00 | $14,996.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.98 / $560.82 / $744.84
| Facility | | $436.98 | $560.82 | $744.84 |
- 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
- $561.69 / $561.69 / $561.69
| Facility | | $561.69 | $561.69 | $561.69 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $55.55 / $55.55 / $55.55
| Facility | AS | $55.55 | $55.55 | $55.55 |
- 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 |