- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $816.17 / $816.17 / $6,781.00
| Facility | | $816.17 | $816.17 | $6,781.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,789.49 / $12,446.60 / $25,424.06
| Facility | | $3,789.49 | $12,446.60 | $25,424.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,981.67 / $2,811.70 / $6,763.92
| Facility | | $1,981.67 | $2,811.70 | $6,763.92 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $92.68 / $92.68 / $92.68
| Facility | AS | $92.68 | $92.68 | $92.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,801.52 / $2,570.57 / $5,325.93
| Facility | | $1,801.52 | $2,570.57 | $5,325.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $895.61 / $1,538.44 / $7,773.80
| Facility | | $895.61 | $1,538.44 | $7,773.80 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $210.47 / $210.47 / $210.47
| Facility | AS | $210.47 | $210.47 | $210.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,940.00 / $7,872.00 / $11,531.00
| Facility | | $3,940.00 | $7,872.00 | $11,531.00 |