- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $935.33 / $935.33 / $6,781.00
| Facility | | $935.33 | $935.33 | $6,781.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,163.91 / $12,811.26 / $25,424.06
| Facility | | $4,163.91 | $12,811.26 | $25,424.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,279.67 / $3,234.53 / $7,781.10
| Facility | | $2,279.67 | $3,234.53 | $7,781.10 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $110.17 / $110.17 / $110.17
| Facility | AS | $110.17 | $110.17 | $110.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,072.42 / $2,957.14 / $6,126.85
| Facility | | $2,072.42 | $2,957.14 | $6,126.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $980.49 / $1,639.17 / $5,100.00
| Facility | | $980.49 | $1,639.17 | $5,100.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $242.85 / $242.85 / $242.85
| Facility | AS | $242.85 | $242.85 | $242.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,457.00 / $9,370.00 / $12,774.00
| Facility | | $5,457.00 | $9,370.00 | $12,774.00 |