- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $730.16 / $5,785.98 / $6,575.00
| Facility | | $730.16 | $5,785.98 | $6,575.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,447.45 / $22,439.74 / $46,771.99
| Facility | | $3,447.45 | $22,439.74 | $46,771.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,772.05 / $2,514.29 / $6,048.45
| Facility | | $1,772.05 | $2,514.29 | $6,048.45 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $81.76 / $81.76 / $81.76
| Facility | AS | $81.76 | $81.76 | $81.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,610.96 / $2,298.66 / $4,762.56
| Facility | | $1,610.96 | $2,298.66 | $4,762.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $799.67 / $1,372.72 / $9,370.00
| Facility | | $799.67 | $1,372.72 | $9,370.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $187.92 / $187.92 / $187.92
| Facility | AS | $187.92 | $187.92 | $187.92 |
- 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 |