- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $852.79 / $852.79 / $6,575.00
| Facility | | $852.79 | $852.79 | $6,575.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,037.51 / $22,439.74 / $46,771.99
| Facility | | $4,037.51 | $22,439.74 | $46,771.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,069.21 / $2,935.92 / $7,062.76
| Facility | | $2,069.21 | $2,935.92 | $7,062.76 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $97.05 / $97.05 / $97.05
| Facility | AS | $97.05 | $97.05 | $97.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,881.11 / $2,684.14 / $5,561.23
| Facility | | $1,881.11 | $2,684.14 | $5,561.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $882.84 / $1,484.77 / $6,210.20
| Facility | | $882.84 | $1,484.77 | $6,210.20 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $219.82 / $219.82 / $219.82
| Facility | AS | $219.82 | $219.82 | $219.82 |
- 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 |