- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $976.40 / $976.40 / $6,781.00
| Facility | | $976.40 | $976.40 | $6,781.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,088.76 / $4,433.97 / $7,849.51
| Facility | | $2,088.76 | $4,433.97 | $7,849.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,356.28 / $3,343.22 / $8,042.58
| Facility | | $2,356.28 | $3,343.22 | $8,042.58 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $109.68 / $109.68 / $109.68
| Facility | AS | $109.68 | $109.68 | $109.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,142.07 / $3,056.51 / $6,332.74
| Facility | | $2,142.07 | $3,056.51 | $6,332.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $976.40 / $1,650.12 / $5,100.00
| Facility | | $976.40 | $1,650.12 | $5,100.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $247.35 / $247.35 / $247.35
| Facility | AS | $247.35 | $247.35 | $247.35 |
- 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 |