- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $773.96 / $2,895.00 / $11,492.70
| Facility | | $773.96 | $2,895.00 | $11,492.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,707.00 / $6,932.00 / $30,285.00
| Facility | | $2,707.00 | $6,932.00 | $30,285.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $579.67 / $743.98 / $988.10
| Facility | | $579.67 | $743.98 | $988.10 |
- 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
- $740.17 / $740.17 / $1,285.14
| Facility | | $740.17 | $740.17 | $1,285.14 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $73.45 / $73.45 / $73.45
| Facility | AS | $73.45 | $73.45 | $73.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,070.00 / $8,440.00 / $13,382.00
| Facility | | $4,070.00 | $8,440.00 | $13,382.00 |