- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $697.32 / $5,072.00 / $11,581.00
| Facility | | $697.32 | $5,072.00 | $11,581.00 |
- 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
- $576.85 / $740.34 / $983.27
| Facility | | $576.85 | $740.34 | $983.27 |
- 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
- $738.76 / $738.76 / $738.76
| Facility | | $738.76 | $738.76 | $738.76 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $73.37 / $73.37 / $73.37
| Facility | AS | $73.37 | $73.37 | $73.37 |
- 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 |