- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $950.00 / $4,197.00 / $10,635.00
| Facility | | $950.00 | $4,197.00 | $10,635.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,760.00 / $4,748.00 / $14,996.00
| Facility | | $1,760.00 | $4,748.00 | $14,996.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $529.54 / $679.63 / $902.64
| Facility | | $529.54 | $679.63 | $902.64 |
- 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
- $678.50 / $678.50 / $678.50
| Facility | | $678.50 | $678.50 | $678.50 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $67.22 / $67.22 / $67.22
| Facility | AS | $67.22 | $67.22 | $67.22 |
- 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 |