- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $864.16 / $864.16 / $2,525.00
| Facility | | $864.16 | $864.16 | $2,525.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,410.12 / $6,420.95 / $12,110.11
| Facility | | $3,410.12 | $6,420.95 | $12,110.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,083.53 / $2,956.23 / $7,111.60
| Facility | | $2,083.53 | $2,956.23 | $7,111.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,894.12 / $2,702.70 / $5,599.69
| Facility | | $1,894.12 | $2,702.70 | $5,599.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $871.00 / $1,460.43 / $3,293.00
| Facility | | $871.00 | $1,460.43 | $3,293.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $215.56 / $215.56 / $215.56
| Facility | AS | $215.56 | $215.56 | $215.56 |
- 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 |