- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $665.09 / $665.09 / $4,828.00
| Facility | | $665.09 | $665.09 | $4,828.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,047.30 / $5,939.08 / $11,966.76
| Facility | | $3,047.30 | $5,939.08 | $11,966.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.36 / $2,300.48 / $5,534.12
| Facility | | $1,621.36 | $2,300.48 | $5,534.12 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $75.45 / $75.45 / $75.45
| Facility | AS | $75.45 | $75.45 | $75.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,473.97 / $2,103.19 / $4,357.58
| Facility | | $1,473.97 | $2,103.19 | $4,357.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $675.87 / $1,317.85 / $5,499.00
| Facility | | $675.87 | $1,317.85 | $5,499.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $171.81 / $171.81 / $171.81
| Facility | AS | $171.81 | $171.81 | $171.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,121.00 / $7,823.25 / $10,734.22
| Facility | | $3,121.00 | $7,823.25 | $10,734.22 |