- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $458.52 / $2,758.27 / $4,828.00
| Facility | | $458.52 | $2,758.27 | $4,828.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,095.12 / $5,939.08 / $11,503.06
| Facility | | $2,095.12 | $5,939.08 | $11,503.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,120.48 / $1,589.79 / $3,824.46
| Facility | | $1,120.48 | $1,589.79 | $3,824.46 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $51.49 / $51.49 / $51.49
| Facility | AS | $51.49 | $51.49 | $51.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,018.61 / $1,453.45 / $3,011.39
| Facility | | $1,018.61 | $1,453.45 | $3,011.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $491.45 / $923.01 / $5,499.00
| Facility | | $491.45 | $923.01 | $5,499.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $118.86 / $118.86 / $118.86
| Facility | AS | $118.86 | $118.86 | $118.86 |
- 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 |