- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $959.81 / $959.81 / $4,828.00
| Facility | | $959.81 | $959.81 | $4,828.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,493.21 / $12,949.86 / $25,424.06
| Facility | | $4,493.21 | $12,949.86 | $25,424.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,328.50 / $3,303.81 / $7,947.76
| Facility | | $2,328.50 | $3,303.81 | $7,947.76 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $109.46 / $109.46 / $109.46
| Facility | AS | $109.46 | $109.46 | $109.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,116.82 / $3,020.47 / $6,258.08
| Facility | | $2,116.82 | $3,020.47 | $6,258.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $995.03 / $1,645.90 / $5,331.00
| Facility | | $995.03 | $1,645.90 | $5,331.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $248.03 / $248.03 / $248.03
| Facility | AS | $248.03 | $248.03 | $248.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,940.00 / $7,872.00 / $11,531.00
| Facility | | $3,940.00 | $7,872.00 | $11,531.00 |