- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $898.10 / $898.10 / $4,828.00
| Facility | | $898.10 | $898.10 | $4,828.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,561.77 / $6,420.95 / $12,648.69
| Facility | | $3,561.77 | $6,420.95 | $12,648.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,166.87 / $3,074.48 / $7,396.07
| Facility | | $2,166.87 | $3,074.48 | $7,396.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,969.88 / $2,810.81 / $5,823.68
| Facility | | $1,969.88 | $2,810.81 | $5,823.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $910.00 / $1,517.79 / $3,293.00
| Facility | | $910.00 | $1,517.79 | $3,293.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $224.15 / $224.15 / $224.15
| Facility | AS | $224.15 | $224.15 | $224.15 |
- 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 |