- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.84 / $501.84 / $6,575.00
| Facility | | $501.84 | $501.84 | $6,575.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,253.82 / $5,939.08 / $11,503.06
| Facility | | $2,253.82 | $5,939.08 | $11,503.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,221.50 / $1,733.13 / $4,169.27
| Facility | | $1,221.50 | $1,733.13 | $4,169.27 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $56.52 / $56.52 / $56.52
| Facility | AS | $56.52 | $56.52 | $56.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,110.45 / $1,584.49 / $3,282.89
| Facility | | $1,110.45 | $1,584.49 | $3,282.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $532.79 / $974.44 / $3,293.00
| Facility | | $532.79 | $974.44 | $3,293.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $129.53 / $129.53 / $129.53
| Facility | AS | $129.53 | $129.53 | $129.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,121.00 / $5,499.00 / $9,810.00
| Facility | | $3,121.00 | $5,499.00 | $9,810.00 |