- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $719.48 / $719.48 / $6,575.00
| Facility | | $719.48 | $719.48 | $6,575.00 |
- 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
- $1,749.32 / $2,482.04 / $5,970.87
| Facility | | $1,749.32 | $2,482.04 | $5,970.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,590.29 / $2,269.17 / $4,701.47
| Facility | | $1,590.29 | $2,269.17 | $4,701.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $781.77 / $1,315.46 / $5,331.00
| Facility | | $781.77 | $1,315.46 | $5,331.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $185.81 / $185.81 / $185.81
| Facility | AS | $185.81 | $185.81 | $185.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,940.00 / $7,872.00 / $11,531.00
| Facility | | $3,940.00 | $7,872.00 | $11,531.00 |