- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $492.45 / $492.45 / $6,575.00
| Facility | | $492.45 | $492.45 | $6,575.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,199.32 / $5,939.08 / $11,503.06
| Facility | | $2,199.32 | $5,939.08 | $11,503.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.98 / $1,706.85 / $4,106.05
| Facility | | $1,202.98 | $1,706.85 | $4,106.05 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $55.33 / $55.33 / $55.33
| Facility | AS | $55.33 | $55.33 | $55.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,093.60 / $1,560.47 / $3,233.11
| Facility | | $1,093.60 | $1,560.47 | $3,233.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $492.45 / $862.95 / $4,746.00
| Facility | | $492.45 | $862.95 | $4,746.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $126.66 / $126.66 / $126.66
| Facility | AS | $126.66 | $126.66 | $126.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,412.00 / $3,756.00 / $8,193.00
| Facility | | $2,412.00 | $3,756.00 | $8,193.00 |