- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $673.52 / $673.52 / $4,828.00
| Facility | | $673.52 | $673.52 | $4,828.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,137.75 / $12,197.67 / $25,424.06
| Facility | | $3,137.75 | $12,197.67 | $25,424.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,643.25 / $2,331.54 / $5,608.83
| Facility | | $1,643.25 | $2,331.54 | $5,608.83 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $76.39 / $76.39 / $76.39
| Facility | AS | $76.39 | $76.39 | $76.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,493.87 / $2,131.58 / $4,416.39
| Facility | | $1,493.87 | $2,131.58 | $4,416.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $701.47 / $1,180.04 / $7,603.66
| Facility | | $701.47 | $1,180.04 | $7,603.66 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $174.07 / $174.07 / $174.07
| Facility | AS | $174.07 | $174.07 | $174.07 |
- 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 |