- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $536.38 / $3,866.00 / $6,083.59
| Facility | | $536.38 | $3,866.00 | $6,083.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,734.85 / $6,020.57 / $10,098.06
| Facility | | $2,734.85 | $6,020.57 | $10,098.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,303.99 / $1,850.18 / $4,450.85
| Facility | | $1,303.99 | $1,850.18 | $4,450.85 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $60.88 / $60.88 / $60.88
| Facility | AS | $60.88 | $60.88 | $60.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,185.45 / $1,691.51 / $3,504.61
| Facility | | $1,185.45 | $1,691.51 | $3,504.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $547.40 / $1,041.52 / $4,974.00
| Facility | | $547.40 | $1,041.52 | $4,974.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $138.53 / $138.53 / $138.53
| Facility | AS | $138.53 | $138.53 | $138.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,412.00 / $4,746.00 / $8,812.00
| Facility | | $2,412.00 | $4,746.00 | $8,812.00 |