- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $551.51 / $551.51 / $4,828.00
| Facility | | $551.51 | $551.51 | $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
- $1,345.24 / $1,908.71 / $4,591.64
| Facility | | $1,345.24 | $1,908.71 | $4,591.64 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $62.30 / $62.30 / $62.30
| Facility | AS | $62.30 | $62.30 | $62.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,222.95 / $1,745.02 / $3,615.48
| Facility | | $1,222.95 | $1,745.02 | $3,615.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $560.60 / $1,070.88 / $4,746.00
| Facility | | $560.60 | $1,070.88 | $4,746.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $142.76 / $142.76 / $142.76
| Facility | AS | $142.76 | $142.76 | $142.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,356.00 / $3,312.00 / $8,193.00
| Facility | | $1,356.00 | $3,312.00 | $8,193.00 |