- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $717.12 / $717.12 / $4,828.00
| Facility | | $717.12 | $717.12 | $4,828.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,099.28 / $6,134.65 / $11,966.76
| Facility | | $3,099.28 | $6,134.65 | $11,966.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,742.59 / $2,472.48 / $5,947.89
| Facility | | $1,742.59 | $2,472.48 | $5,947.89 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $81.31 / $81.31 / $81.31
| Facility | AS | $81.31 | $81.31 | $81.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.17 / $2,260.44 / $4,683.38
| Facility | | $1,584.17 | $2,260.44 | $4,683.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.07 / $1,225.76 / $3,991.00
| Facility | | $741.07 | $1,225.76 | $3,991.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $184.74 / $184.74 / $184.74
| Facility | AS | $184.74 | $184.74 | $184.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,740.00 / $3,991.00 / $9,787.00
| Facility | | $2,740.00 | $3,991.00 | $9,787.00 |