- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $967.23 / $967.23 / $7,397.00
| Facility | | $967.23 | $967.23 | $7,397.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,485.18 / $12,926.76 / $25,424.06
| Facility | | $4,485.18 | $12,926.76 | $25,424.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,351.23 / $3,336.06 / $8,025.34
| Facility | | $2,351.23 | $3,336.06 | $8,025.34 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $110.09 / $110.09 / $110.09
| Facility | AS | $110.09 | $110.09 | $110.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.48 / $3,049.96 / $6,319.16
| Facility | | $2,137.48 | $3,049.96 | $6,319.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,016.31 / $1,688.90 / $6,084.00
| Facility | | $1,016.31 | $1,688.90 | $6,084.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $249.83 / $249.83 / $249.83
| Facility | AS | $249.83 | $249.83 | $249.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,572.00 / $10,493.00 / $23,633.78
| Facility | | $4,572.00 | $10,493.00 | $23,633.78 |