- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.31 / $2,447.48 / $4,410.00
| Facility | | $776.31 | $2,447.48 | $4,410.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,061.00 / $2,826.85 / $9,039.00
| Facility | | $1,061.00 | $2,826.85 | $9,039.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $272.27 / $272.27 / $272.27
| Facility | AS | $272.27 | $272.27 | $272.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $637.80 / $819.59 / $1,463.14
| Facility | | $637.80 | $819.59 | $1,463.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $540.29 / $1,162.98 / $6,679.00
| Facility | | $540.29 | $1,162.98 | $6,679.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,902.00 / $3,764.00 / $26,542.00
| Facility | | $1,902.00 | $3,764.00 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $272.27 / $272.27 / $272.27
| Facility | AS | $272.27 | $272.27 | $272.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,902.00 / $3,764.00 / $8,766.00
| Facility | | $1,902.00 | $3,764.00 | $8,766.00 |