- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $374.10 / $510.50 / $10,350.00
| Facility | | $374.10 | $510.50 | $10,350.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,206.67 / $7,465.39 / $14,249.16
| Facility | | $4,206.67 | $7,465.39 | $14,249.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $914.23 / $1,297.16 / $3,120.49
| Facility | | $914.23 | $1,297.16 | $3,120.49 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $41.91 / $41.91 / $41.91
| Facility | AS | $41.91 | $41.91 | $41.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.12 / $1,185.91 / $2,457.08
| Facility | | $831.12 | $1,185.91 | $2,457.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $409.46 / $712.10 / $3,312.00
| Facility | | $409.46 | $712.10 | $3,312.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $97.18 / $97.18 / $97.18
| Facility | AS | $97.18 | $97.18 | $97.18 |
- 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 |