- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $615.66 / $843.29 / $2,525.00
| Facility | | $615.66 | $843.29 | $2,525.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,832.94 / $12,197.67 / $25,424.06
| Facility | | $2,832.94 | $12,197.67 | $25,424.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,044.81 / $2,901.28 / $6,979.43
| Facility | | $2,044.81 | $2,901.28 | $6,979.43 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $105.15 / $105.15 / $105.15
| Facility | AS | $105.15 | $105.15 | $105.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,858.91 / $2,652.47 / $5,495.61
| Facility | | $1,858.91 | $2,652.47 | $5,495.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $690.12 / $1,249.50 / $2,361.17
| Facility | | $690.12 | $1,249.50 | $2,361.17 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $284.14 / $284.14 / $284.14
| Facility | AS | $284.14 | $284.14 | $284.14 |
- 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 |