- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $418.45 / $418.45 / $4,828.00
| Facility | | $418.45 | $418.45 | $4,828.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,107.06 / $4,386.21 / $9,046.11
| Facility | | $2,107.06 | $4,386.21 | $9,046.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,021.98 / $1,450.04 / $3,488.28
| Facility | | $1,021.98 | $1,450.04 | $3,488.28 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $47.39 / $47.39 / $47.39
| Facility | AS | $47.39 | $47.39 | $47.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $929.07 / $1,325.69 / $2,746.68
| Facility | | $929.07 | $1,325.69 | $2,746.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $427.86 / $812.54 / $4,746.00
| Facility | | $427.86 | $812.54 | $4,746.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $108.42 / $108.42 / $108.42
| Facility | AS | $108.42 | $108.42 | $108.42 |
- 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 |