- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $4,786.30 / $10,964.78
| Facility | | $851.14 | $4,786.30 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,456.54 / $7,585.78 / $57,543.99
| Facility | | $6,456.54 | $7,585.78 | $57,543.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $851.14 / $851.14
| Facility | | $851.14 | $851.14 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $85.11 / $85.11 / $85.11
| Facility | AS | $85.11 | $85.11 | $85.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $5,623.41 / $14,454.40
| Facility | | $933.25 | $5,623.41 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $4,265.80 / $10,715.19
| Facility | | $831.76 | $4,265.80 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $794.33 / $1,000.00
| Facility | | $794.33 | $794.33 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $478.63 / $707.95
| Facility | | $478.63 | $478.63 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $3,981.07 / $10,000.00
| Facility | | $2,089.30 | $3,981.07 | $10,000.00 |