- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $983.00 / $3,792.00 / $13,004.00
| Facility | | $983.00 | $3,792.00 | $13,004.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,330.68 / $7,960.68 / $15,711.87
| Facility | | $4,330.68 | $7,960.68 | $15,711.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $845.22 / $6,610.14 / $6,610.14
| Facility | | $845.22 | $6,610.14 | $6,610.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,850.42 / $3,850.42 / $3,850.42
| Facility | | $3,850.42 | $3,850.42 | $3,850.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,500.00 / $26,542.00 / $26,542.00
| Facility | | $11,500.00 | $26,542.00 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $200.69 / $1,442.13 / $1,442.13
| Facility | AS | $200.69 | $1,442.13 | $1,442.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $838.14 / $1,079.93 / $1,980.41
| Facility | | $838.14 | $1,079.93 | $1,980.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $838.14 / $1,123.11 / $2,030.99
| Facility | | $838.14 | $1,123.11 | $2,030.99 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $348.31 / $348.31 / $348.31
| Facility | 80 | $348.31 | $348.31 | $348.31 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $296.06 / $296.06 / $296.06
| Facility | AS | $296.06 | $296.06 | $296.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,093.00 / $6,000.00 / $13,134.00
| Facility | | $2,093.00 | $6,000.00 | $13,134.00 |