- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $908.05 / $2,278.50 / $15,306.07
| Facility | | $908.05 | $2,278.50 | $15,306.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,812.67 / $11,253.87 / $25,424.06
| Facility | | $3,812.67 | $11,253.87 | $25,424.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,205.59 / $3,129.42 / $7,528.24
| Facility | | $2,205.59 | $3,129.42 | $7,528.24 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $103.31 / $103.31 / $103.31
| Facility | AS | $103.31 | $103.31 | $103.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,005.09 / $2,861.04 / $5,927.75
| Facility | | $2,005.09 | $2,861.04 | $5,927.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $908.05 / $1,836.85 / $5,913.00
| Facility | | $908.05 | $1,836.85 | $5,913.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $234.10 / $234.10 / $234.10
| Facility | AS | $234.10 | $234.10 | $234.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,457.00 / $11,890.00 / $23,633.78
| Facility | | $5,457.00 | $11,890.00 | $23,633.78 |