- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $534.60 / $534.60 / $4,828.00
| Facility | | $534.60 | $534.60 | $4,828.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.02 / $11,253.87 / $25,424.06
| Facility | | $2,630.02 | $11,253.87 | $25,424.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,300.63 / $1,845.40 / $4,439.35
| Facility | | $1,300.63 | $1,845.40 | $4,439.35 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $60.51 / $60.51 / $60.51
| Facility | AS | $60.51 | $60.51 | $60.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,182.39 / $1,687.14 / $3,495.56
| Facility | | $1,182.39 | $1,687.14 | $3,495.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $555.85 / $937.12 / $5,577.00
| Facility | | $555.85 | $937.12 | $5,577.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $138.38 / $138.38 / $138.38
| Facility | AS | $138.38 | $138.38 | $138.38 |
- 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 |