- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $834.41 / $834.41 / $6,781.00
| Facility | | $834.41 | $834.41 | $6,781.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,939.71 / $22,439.74 / $46,771.99
| Facility | | $3,939.71 | $22,439.74 | $46,771.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,027.97 / $2,877.39 / $6,921.96
| Facility | | $2,027.97 | $2,877.39 | $6,921.96 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $95.07 / $95.07 / $95.07
| Facility | AS | $95.07 | $95.07 | $95.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,843.61 / $2,630.63 / $5,450.36
| Facility | | $1,843.61 | $2,630.63 | $5,450.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $865.51 / $1,456.73 / $9,370.00
| Facility | | $865.51 | $1,456.73 | $9,370.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $215.63 / $215.63 / $215.63
| Facility | AS | $215.63 | $215.63 | $215.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,457.00 / $9,370.00 / $12,774.00
| Facility | | $5,457.00 | $9,370.00 | $12,774.00 |