- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $680.81 / $680.81 / $4,828.00
| Facility | | $680.81 | $680.81 | $4,828.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,307.93 / $4,844.72 / $10,098.06
| Facility | | $1,307.93 | $4,844.72 | $10,098.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,652.51 / $2,344.67 / $5,640.44
| Facility | | $1,652.51 | $2,344.67 | $5,640.44 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $78.22 / $78.22 / $78.22
| Facility | AS | $78.22 | $78.22 | $78.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,502.28 / $2,143.60 / $4,441.29
| Facility | | $1,502.28 | $2,143.60 | $4,441.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $705.65 / $1,334.97 / $4,746.00
| Facility | | $705.65 | $1,334.97 | $4,746.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $176.07 / $176.07 / $176.07
| Facility | AS | $176.07 | $176.07 | $176.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,412.00 / $4,746.00 / $8,812.00
| Facility | | $2,412.00 | $4,746.00 | $8,812.00 |