- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $618.28 / $618.28 / $2,525.00
| Facility | | $618.28 | $618.28 | $2,525.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,507.17 / $13,558.82 / $26,448.94
| Facility | | $5,507.17 | $13,558.82 | $26,448.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,502.67 / $2,132.07 / $5,128.97
| Facility | | $1,502.67 | $2,132.07 | $5,128.97 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $69.76 / $69.76 / $69.76
| Facility | AS | $69.76 | $69.76 | $69.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,366.06 / $1,949.22 / $4,038.56
| Facility | | $1,366.06 | $1,949.22 | $4,038.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $647.67 / $1,052.15 / $3,462.48
| Facility | | $647.67 | $1,052.15 | $3,462.48 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $158.81 / $158.81 / $158.81
| Facility | AS | $158.81 | $158.81 | $158.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,121.00 / $9,404.00 / $23,633.78
| Facility | | $3,121.00 | $9,404.00 | $23,633.78 |