- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,074.28 / $1,074.28 / $6,575.00
| Facility | | $1,074.28 | $1,074.28 | $6,575.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,090.49 / $22,897.69 / $46,771.99
| Facility | | $5,090.49 | $22,897.69 | $46,771.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,607.15 / $3,699.17 / $8,898.84
| Facility | | $2,607.15 | $3,699.17 | $8,898.84 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $122.40 / $122.40 / $122.40
| Facility | AS | $122.40 | $122.40 | $122.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,370.13 / $3,381.92 / $7,006.96
| Facility | | $2,370.13 | $3,381.92 | $7,006.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,113.61 / $1,834.18 / $9,370.00
| Facility | | $1,113.61 | $1,834.18 | $9,370.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $276.58 / $276.58 / $276.58
| Facility | AS | $276.58 | $276.58 | $276.58 |
- 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 |