- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $716.12 / $716.12 / $6,955.00
| Facility | | $716.12 | $716.12 | $6,955.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,040.24 / $5,572.33 / $10,098.06
| Facility | | $3,040.24 | $5,572.33 | $10,098.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.54 / $2,465.31 / $5,930.65
| Facility | | $1,737.54 | $2,465.31 | $5,930.65 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $82.39 / $82.39 / $82.39
| Facility | AS | $82.39 | $82.39 | $82.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,579.58 / $2,253.89 / $4,669.80
| Facility | | $1,579.58 | $2,253.89 | $4,669.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $740.98 / $1,419.12 / $4,974.00
| Facility | | $740.98 | $1,419.12 | $4,974.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $184.92 / $184.92 / $184.92
| Facility | AS | $184.92 | $184.92 | $184.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,412.00 / $4,746.00 / $8,812.00
| Facility | | $2,412.00 | $4,746.00 | $8,812.00 |