- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $594.52 / $594.52 / $4,828.00
| Facility | | $594.52 | $594.52 | $4,828.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,885.31 / $6,134.65 / $11,503.06
| Facility | | $2,885.31 | $6,134.65 | $11,503.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,443.74 / $2,048.46 / $4,927.84
| Facility | | $1,443.74 | $2,048.46 | $4,927.84 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $67.22 / $67.22 / $67.22
| Facility | AS | $67.22 | $67.22 | $67.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,312.49 / $1,872.78 / $3,880.19
| Facility | | $1,312.49 | $1,872.78 | $3,880.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.89 / $1,039.31 / $5,913.00
| Facility | | $606.89 | $1,039.31 | $5,913.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $153.41 / $153.41 / $153.41
| Facility | AS | $153.41 | $153.41 | $153.41 |
- 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 |