- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $914.02 / $914.02 / $2,525.00
| Facility | | $914.02 | $914.02 | $2,525.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,088.76 / $4,433.97 / $7,761.22
| Facility | | $2,088.76 | $4,433.97 | $7,761.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,239.27 / $3,177.20 / $7,643.18
| Facility | | $2,239.27 | $3,177.20 | $7,643.18 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $104.84 / $104.84 / $104.84
| Facility | AS | $104.84 | $104.84 | $104.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,035.70 / $2,904.72 / $6,018.25
| Facility | | $2,035.70 | $2,904.72 | $6,018.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.07 / $1,579.09 / $2,807.26
| Facility | | $933.07 | $1,579.09 | $2,807.26 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $239.99 / $239.99 / $239.99
| Facility | AS | $239.99 | $239.99 | $239.99 |
- 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 |