- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $881.93 / $881.93 / $11,051.42
| Facility | | $881.93 | $881.93 | $11,051.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $370.96 / $778.05 / $6,973.83
| Facility | | $370.96 | $778.05 | $6,973.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,177.81 / $3,090.00 / $7,433.42
| Facility | | $2,177.81 | $3,090.00 | $7,433.42 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $106.59 / $106.59 / $106.59
| Facility | AS | $106.59 | $106.59 | $106.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,979.83 / $2,825.00 / $5,853.09
| Facility | | $1,979.83 | $2,825.00 | $5,853.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $944.55 / $1,567.31 / $2,645.80
| Facility | | $944.55 | $1,567.31 | $2,645.80 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $233.45 / $233.45 / $233.45
| Facility | AS | $233.45 | $233.45 | $233.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,720.00 / $3,500.00 / $8,152.00
| Facility | | $1,720.00 | $3,500.00 | $8,152.00 |