- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $971.55 / $971.55 / $2,525.00
| Facility | | $971.55 | $971.55 | $2,525.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,724.04 / $12,222.68 / $23,673.40
| Facility | | $4,724.04 | $12,222.68 | $23,673.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,385.75 / $3,385.03 / $8,143.14
| Facility | | $2,385.75 | $3,385.03 | $8,143.14 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $112.26 / $112.26 / $112.26
| Facility | AS | $112.26 | $112.26 | $112.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,168.86 / $3,094.73 / $6,411.93
| Facility | | $2,168.86 | $3,094.73 | $6,411.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $949.82 / $1,668.19 / $5,331.00
| Facility | | $949.82 | $1,668.19 | $5,331.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $251.53 / $251.53 / $251.53
| Facility | AS | $251.53 | $251.53 | $251.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,190.00 / $4,675.00 / $11,165.00
| Facility | | $3,190.00 | $4,675.00 | $11,165.00 |