- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $368.82 / $368.82 / $2,525.00
| Facility | | $368.82 | $368.82 | $2,525.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,769.71 / $30,003.09 / $63,379.48
| Facility | | $1,769.71 | $30,003.09 | $63,379.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $915.91 / $1,299.55 / $3,126.23
| Facility | | $915.91 | $1,299.55 | $3,126.23 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $43.55 / $43.55 / $43.55
| Facility | AS | $43.55 | $43.55 | $43.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $832.65 / $1,188.09 / $2,461.60
| Facility | | $832.65 | $1,188.09 | $2,461.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $413.86 / $664.15 / $7,518.00
| Facility | | $413.86 | $664.15 | $7,518.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $97.26 / $97.26 / $97.26
| Facility | AS | $97.26 | $97.26 | $97.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,891.00 / $12,967.00 / $32,027.00
| Facility | | $5,891.00 | $12,967.00 | $32,027.00 |