- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $717.31 / $2,936.00 / $10,268.00
| Facility | | $717.31 | $2,936.00 | $10,268.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,712.00 / $3,264.00 / $14,996.00
| Facility | | $1,712.00 | $3,264.00 | $14,996.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $442.38 / $567.76 / $754.05
| Facility | | $442.38 | $567.76 | $754.05 |
- 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
- $565.41 / $565.41 / $565.41
| Facility | | $565.41 | $565.41 | $565.41 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $56.11 / $56.11 / $56.11
| Facility | AS | $56.11 | $56.11 | $56.11 |
- 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 |