- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.56 / $911.93 / $2,168.00
| Facility | | $436.56 | $911.93 | $2,168.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,110.85 / $11,660.74 / $24,304.92
| Facility | | $2,110.85 | $11,660.74 | $24,304.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,051.77 / $3,202.28 / $7,703.52
| Facility | | $2,051.77 | $3,202.28 | $7,703.52 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $76.80 / $76.80 / $76.80
| Facility | AS | $76.80 | $76.80 | $76.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,835.68 / $2,927.65 / $6,065.76
| Facility | | $1,835.68 | $2,927.65 | $6,065.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $605.67 / $1,176.46 / $2,715.94
| Facility | | $605.67 | $1,176.46 | $2,715.94 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $205.58 / $205.58 / $205.58
| Facility | AS | $205.58 | $205.58 | $205.58 |
- 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 |