- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $856.80 / $856.80 / $6,575.00
| Facility | | $856.80 | $856.80 | $6,575.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,593.93 / $12,197.67 / $25,424.06
| Facility | | $3,593.93 | $12,197.67 | $25,424.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,069.21 / $2,935.92 / $7,062.76
| Facility | | $2,069.21 | $2,935.92 | $7,062.76 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $94.51 / $94.51 / $94.51
| Facility | AS | $94.51 | $94.51 | $94.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,881.11 / $2,684.14 / $5,561.23
| Facility | | $1,881.11 | $2,684.14 | $5,561.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $856.80 / $1,447.99 / $3,991.00
| Facility | | $856.80 | $1,447.99 | $3,991.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $215.31 / $215.31 / $215.31
| Facility | AS | $215.31 | $215.31 | $215.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,121.00 / $5,499.00 / $9,810.00
| Facility | | $3,121.00 | $5,499.00 | $9,810.00 |