- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $720.85 / $720.85 / $4,828.00
| Facility | | $720.85 | $720.85 | $4,828.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,386.52 / $4,844.72 / $10,098.06
| Facility | | $1,386.52 | $4,844.72 | $10,098.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,743.43 / $2,473.67 / $5,950.76
| Facility | | $1,743.43 | $2,473.67 | $5,950.76 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $82.62 / $82.62 / $82.62
| Facility | AS | $82.62 | $82.62 | $82.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.94 / $2,261.53 / $4,685.64
| Facility | | $1,584.94 | $2,261.53 | $4,685.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $745.59 / $1,399.72 / $4,746.00
| Facility | | $745.59 | $1,399.72 | $4,746.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $185.88 / $185.88 / $185.88
| Facility | AS | $185.88 | $185.88 | $185.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,412.00 / $4,746.00 / $8,812.00
| Facility | | $2,412.00 | $4,746.00 | $8,812.00 |