- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $829.25 / $829.25 / $6,781.00
| Facility | | $829.25 | $829.25 | $6,781.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,802.32 / $12,446.60 / $25,424.06
| Facility | | $3,802.32 | $12,446.60 | $25,424.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,020.39 / $2,866.64 / $6,896.10
| Facility | | $2,020.39 | $2,866.64 | $6,896.10 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $94.06 / $94.06 / $94.06
| Facility | AS | $94.06 | $94.06 | $94.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,836.72 / $2,620.80 / $5,430.00
| Facility | | $1,836.72 | $2,620.80 | $5,430.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $863.85 / $1,688.44 / $10,693.45
| Facility | | $863.85 | $1,688.44 | $10,693.45 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $214.46 / $214.46 / $214.46
| Facility | AS | $214.46 | $214.46 | $214.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,577.00 / $9,370.00 / $12,774.00
| Facility | | $5,577.00 | $9,370.00 | $12,774.00 |