- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $713.22 / $713.22 / $4,828.00
| Facility | | $713.22 | $713.22 | $4,828.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,088.76 / $3,977.68 / $6,499.58
| Facility | | $2,088.76 | $3,977.68 | $6,499.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,745.11 / $2,476.06 / $5,956.51
| Facility | | $1,745.11 | $2,476.06 | $5,956.51 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $81.56 / $81.56 / $81.56
| Facility | AS | $81.56 | $81.56 | $81.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,586.47 / $2,263.71 / $4,690.16
| Facility | | $1,586.47 | $2,263.71 | $4,690.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $713.22 / $1,222.63 / $2,173.57
| Facility | | $713.22 | $1,222.63 | $2,173.57 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $185.86 / $185.86 / $185.86
| Facility | AS | $185.86 | $185.86 | $185.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,457.00 / $9,370.00 / $12,774.00
| Facility | | $5,457.00 | $9,370.00 | $12,774.00 |