- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,076.14 / $5,223.00 / $11,581.00
| Facility | | $1,076.14 | $5,223.00 | $11,581.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,670.00 / $5,770.00 / $30,285.00
| Facility | | $2,670.00 | $5,770.00 | $30,285.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $535.91 / $687.79 / $913.47
| Facility | | $535.91 | $687.79 | $913.47 |
- 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
- $691.52 / $2,900.72 / $7,871.93
| Facility | | $691.52 | $2,900.72 | $7,871.93 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $69.08 / $69.08 / $69.08
| Facility | AS | $69.08 | $69.08 | $69.08 |
- 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 |