- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $627.21 / $3,416.90 / $10,268.00
| Facility | | $627.21 | $3,416.90 | $10,268.00 |
- 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
- $377.15 / $484.04 / $642.87
| Facility | | $377.15 | $484.04 | $642.87 |
- 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
- $682.37 / $2,278.15 / $8,230.37
| Facility | | $682.37 | $2,278.15 | $8,230.37 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $72.42 / $72.42 / $72.42
| Facility | AS | $72.42 | $72.42 | $72.42 |
- 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 |