- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $657.83 / $4,380.00 / $28,666.76
| Facility | | $657.83 | $4,380.00 | $28,666.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,066.03 / $12,197.67 / $25,424.06
| Facility | | $3,066.03 | $12,197.67 | $25,424.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,603.69 / $2,275.40 / $5,473.78
| Facility | | $1,603.69 | $2,275.40 | $5,473.78 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $74.45 / $74.45 / $74.45
| Facility | AS | $74.45 | $74.45 | $74.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,457.90 / $2,080.26 / $4,310.06
| Facility | | $1,457.90 | $2,080.26 | $4,310.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $688.04 / $1,151.22 / $7,916.60
| Facility | | $688.04 | $1,151.22 | $7,916.60 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $169.67 / $169.67 / $169.67
| Facility | AS | $169.67 | $169.67 | $169.67 |
- 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 |