- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $578.58 / $2,895.00 / $10,635.00
| Facility | | $578.58 | $2,895.00 | $10,635.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,760.00 / $3,405.00 / $14,996.00
| Facility | | $1,760.00 | $3,405.00 | $14,996.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $372.22 / $477.71 / $591.27
| Facility | | $372.22 | $477.71 | $591.27 |
- 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
- $714.12 / $714.12 / $714.12
| Facility | | $714.12 | $714.12 | $714.12 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $71.41 / $71.41 / $71.41
| Facility | AS | $71.41 | $71.41 | $71.41 |
- 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 |