- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $767.61 / $767.61 / $2,168.00
| Facility | | $767.61 | $767.61 | $2,168.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,538.78 / $6,598.98 / $13,089.90
| Facility | | $3,538.78 | $6,598.98 | $13,089.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,851.18 / $2,626.56 / $6,318.55
| Facility | | $1,851.18 | $2,626.56 | $6,318.55 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $84.30 / $84.30 / $84.30
| Facility | AS | $84.30 | $84.30 | $84.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,682.89 / $2,401.31 / $4,975.24
| Facility | | $1,682.89 | $2,401.31 | $4,975.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $767.61 / $1,297.26 / $3,293.00
| Facility | | $767.61 | $1,297.26 | $3,293.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $192.10 / $192.10 / $192.10
| Facility | AS | $192.10 | $192.10 | $192.10 |
- 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 |