- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $408.23 / $622.34 / $6,205.00
| Facility | | $408.23 | $622.34 | $6,205.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,214.76 / $13,287.64 / $25,585.41
| Facility | | $4,214.76 | $13,287.64 | $25,585.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,522.03 / $2,159.54 / $5,195.06
| Facility | | $1,522.03 | $2,159.54 | $5,195.06 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $69.45 / $69.45 / $69.45
| Facility | AS | $69.45 | $69.45 | $69.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,369.74 / $1,974.34 / $4,090.60
| Facility | | $1,369.74 | $1,974.34 | $4,090.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $505.06 / $835.30 / $1,830.76
| Facility | | $505.06 | $835.30 | $1,830.76 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $188.17 / $188.17 / $188.17
| Facility | AS | $188.17 | $188.17 | $188.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,412.00 / $4,746.00 / $8,812.00
| Facility | | $2,412.00 | $4,746.00 | $8,812.00 |