- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $768.83 / $768.83 / $4,828.00
| Facility | | $768.83 | $768.83 | $4,828.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,684.19 / $12,197.67 / $25,424.06
| Facility | | $2,684.19 | $12,197.67 | $25,424.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,857.08 / $2,634.92 / $6,338.67
| Facility | | $1,857.08 | $2,634.92 | $6,338.67 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $87.09 / $87.09 / $87.09
| Facility | AS | $87.09 | $87.09 | $87.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,688.25 / $2,408.94 / $4,991.08
| Facility | | $1,688.25 | $2,408.94 | $4,991.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $781.57 / $1,299.32 / $5,913.00
| Facility | | $781.57 | $1,299.32 | $5,913.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $194.76 / $194.76 / $194.76
| Facility | AS | $194.76 | $194.76 | $194.76 |
- 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 |