- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $763.09 / $3,195.25 / $6,955.00
| Facility | | $763.09 | $3,195.25 | $6,955.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,550.65 / $12,197.67 / $25,424.06
| Facility | | $3,550.65 | $12,197.67 | $25,424.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,853.71 / $2,630.15 / $6,327.17
| Facility | | $1,853.71 | $2,630.15 | $6,327.17 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $86.46 / $86.46 / $86.46
| Facility | AS | $86.46 | $86.46 | $86.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,685.19 / $2,404.58 / $4,982.03
| Facility | | $1,685.19 | $2,404.58 | $4,982.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $825.72 / $1,436.04 / $9,370.00
| Facility | | $825.72 | $1,436.04 | $9,370.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $196.41 / $196.41 / $196.41
| Facility | AS | $196.41 | $196.41 | $196.41 |
- 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 |