- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $402.92 / $10,419.65 / $18,069.12
| Facility | | $402.92 | $10,419.65 | $18,069.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,473.00 / $7,890.00 / $20,600.00
| Facility | | $3,473.00 | $7,890.00 | $20,600.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $294.70 / $383.12 / $442.07
| Facility | | $294.70 | $383.12 | $442.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $375.23 / $615.00 / $3,833.32
| Facility | | $375.23 | $615.00 | $3,833.32 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $37.06 / $37.06 / $37.06
| Facility | AS | $37.06 | $37.06 | $37.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,529.00 / $9,550.00 / $15,750.00
| Facility | | $2,529.00 | $9,550.00 | $15,750.00 |