- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $969.67 / $3,713.44 / $10,268.00
| Facility | | $969.67 | $3,713.44 | $10,268.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,777.00 / $5,770.00 / $30,285.00
| Facility | | $2,777.00 | $5,770.00 | $30,285.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $638.33 / $819.24 / $1,088.06
| Facility | | $638.33 | $819.24 | $1,088.06 |
- 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
- $815.76 / $1,725.69 / $5,690.46
| Facility | | $815.76 | $1,725.69 | $5,690.46 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $80.87 / $80.87 / $80.87
| Facility | AS | $80.87 | $80.87 | $80.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,206.00 / $6,231.00 / $10,075.00
| Facility | | $3,206.00 | $6,231.00 | $10,075.00 |