- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $5,754.40 / $10,000.00
| Facility | | $912.01 | $5,754.40 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $24,547.09 / $58,884.37
| Facility | | $5,495.41 | $24,547.09 | $58,884.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $3,388.44 / $7,943.28
| Facility | | $2,344.23 | $3,388.44 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $158.49 / $158.49 / $158.49
| Facility | AS | $158.49 | $158.49 | $158.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $3,235.94 / $6,309.57
| Facility | | $2,570.40 | $3,235.94 | $6,309.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $1,819.70 / $11,220.18
| Facility | | $954.99 | $1,819.70 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $9,332.54 / $13,182.57
| Facility | | $4,570.88 | $9,332.54 | $13,182.57 |