- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $696.96 / $696.96 / $2,168.00
| Facility | | $696.96 | $696.96 | $2,168.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,368.04 / $12,197.67 / $28,063.36
| Facility | | $2,368.04 | $12,197.67 | $28,063.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,676.08 / $2,378.12 / $5,720.89
| Facility | | $1,676.08 | $2,378.12 | $5,720.89 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $84.30 / $84.30 / $84.30
| Facility | AS | $84.30 | $84.30 | $84.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,523.71 / $2,174.17 / $4,504.64
| Facility | | $1,523.71 | $2,174.17 | $4,504.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $766.38 / $1,208.93 / $5,913.00
| Facility | | $766.38 | $1,208.93 | $5,913.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $180.10 / $180.10 / $180.10
| Facility | AS | $180.10 | $180.10 | $180.10 |
- 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 |