- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $612.57 / $3,325.00 / $11,581.00
| Facility | | $612.57 | $3,325.00 | $11,581.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,670.00 / $5,544.00 / $30,285.00
| Facility | | $2,670.00 | $5,544.00 | $30,285.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $370.25 / $403.91 / $588.15
| Facility | | $370.25 | $403.91 | $588.15 |
- 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
- $481.68 / $481.68 / $481.68
| Facility | | $481.68 | $481.68 | $481.68 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $48.17 / $48.17 / $48.17
| Facility | AS | $48.17 | $48.17 | $48.17 |
- 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 |