- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $920.25 / $920.25 / $6,858.00
| Facility | | $920.25 | $920.25 | $6,858.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.14 / $22,439.74 / $46,771.99
| Facility | | $4,365.14 | $22,439.74 | $46,771.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,239.27 / $3,177.20 / $7,643.18
| Facility | | $2,239.27 | $3,177.20 | $7,643.18 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $104.91 / $104.91 / $104.91
| Facility | AS | $104.91 | $104.91 | $104.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,035.70 / $2,904.72 / $6,018.25
| Facility | | $2,035.70 | $2,904.72 | $6,018.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $956.23 / $1,608.21 / $9,370.00
| Facility | | $956.23 | $1,608.21 | $9,370.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $238.06 / $238.06 / $238.06
| Facility | AS | $238.06 | $238.06 | $238.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,457.00 / $11,890.00 / $42,567.62
| Facility | | $5,457.00 | $11,890.00 | $42,567.62 |