- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $877.15 / $877.15 / $21,874.70
| Facility | | $877.15 | $877.15 | $21,874.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,119.01 / $22,439.74 / $46,771.99
| Facility | | $4,119.01 | $22,439.74 | $46,771.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,130.67 / $3,023.12 / $7,272.51
| Facility | | $2,130.67 | $3,023.12 | $7,272.51 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $99.62 / $99.62 / $99.62
| Facility | AS | $99.62 | $99.62 | $99.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,936.97 / $2,763.85 / $5,726.39
| Facility | | $1,936.97 | $2,763.85 | $5,726.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $909.57 / $1,529.73 / $9,370.00
| Facility | | $909.57 | $1,529.73 | $9,370.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $226.16 / $226.16 / $226.16
| Facility | AS | $226.16 | $226.16 | $226.16 |
- 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 |