- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $580.11 / $800.98 / $6,205.00
| Facility | | $580.11 | $800.98 | $6,205.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,702.54 / $12,197.67 / $25,424.06
| Facility | | $2,702.54 | $12,197.67 | $25,424.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,946.31 / $2,761.53 / $6,643.24
| Facility | | $1,946.31 | $2,761.53 | $6,643.24 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $98.49 / $98.49 / $98.49
| Facility | AS | $98.49 | $98.49 | $98.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,769.37 / $2,524.69 / $5,230.89
| Facility | | $1,769.37 | $2,524.69 | $5,230.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $637.66 / $1,176.65 / $2,237.64
| Facility | | $637.66 | $1,176.65 | $2,237.64 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $266.74 / $266.74 / $266.74
| Facility | AS | $266.74 | $266.74 | $266.74 |
- 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 |