- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.82 / $501.82 / $3,523.00
| Facility | | $501.82 | $501.82 | $3,523.00 |
- 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
- $1,219.81 / $1,730.74 / $4,163.52
| Facility | | $1,219.81 | $1,730.74 | $4,163.52 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $56.11 / $56.11 / $56.11
| Facility | AS | $56.11 | $56.11 | $56.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,108.92 / $1,582.31 / $3,278.36
| Facility | | $1,108.92 | $1,582.31 | $3,278.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $520.00 / $867.50 / $3,312.00
| Facility | | $520.00 | $867.50 | $3,312.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $129.69 / $129.69 / $129.69
| Facility | AS | $129.69 | $129.69 | $129.69 |
- 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 |