- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $67.08 / $640.83 / $13,038.49
| Facility | | $67.08 | $640.83 | $13,038.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,989.42 / $12,197.67 / $25,424.06
| Facility | | $2,989.42 | $12,197.67 | $25,424.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,555.70 / $2,207.32 / $5,310.00
| Facility | | $1,555.70 | $2,207.32 | $5,310.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $71.98 / $71.98 / $71.98
| Facility | AS | $71.98 | $71.98 | $71.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,414.27 / $2,018.02 / $4,181.10
| Facility | | $1,414.27 | $2,018.02 | $4,181.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.21 / $1,207.24 / $5,499.00
| Facility | | $691.21 | $1,207.24 | $5,499.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $165.43 / $165.43 / $620.23
| Facility | AS | $165.43 | $165.43 | $620.23 |
- 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 |