- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $828.58 / $828.58 / $2,168.00
| Facility | | $828.58 | $828.58 | $2,168.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,122.27 / $21,428.46 / $48,409.91
| Facility | | $4,122.27 | $21,428.46 | $48,409.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,058.27 / $2,920.39 / $7,025.40
| Facility | | $2,058.27 | $2,920.39 | $7,025.40 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $100.85 / $100.85 / $100.85
| Facility | AS | $100.85 | $100.85 | $100.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,871.16 / $2,669.94 / $5,531.81
| Facility | | $1,871.16 | $2,669.94 | $5,531.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $888.03 / $1,595.36 / $9,370.00
| Facility | | $888.03 | $1,595.36 | $9,370.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $218.90 / $218.90 / $218.90
| Facility | AS | $218.90 | $218.90 | $218.90 |
- 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 |