- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $737.19 / $737.19 / $6,781.00
| Facility | | $737.19 | $737.19 | $6,781.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,088.76 / $4,101.97 / $6,499.58
| Facility | | $2,088.76 | $4,101.97 | $6,499.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,787.21 / $2,535.79 / $6,100.18
| Facility | | $1,787.21 | $2,535.79 | $6,100.18 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $84.03 / $84.03 / $84.03
| Facility | AS | $84.03 | $84.03 | $84.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,624.73 / $2,318.32 / $4,803.29
| Facility | | $1,624.73 | $2,318.32 | $4,803.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $737.19 / $1,248.19 / $2,219.01
| Facility | | $737.19 | $1,248.19 | $2,219.01 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $190.11 / $190.11 / $190.11
| Facility | AS | $190.11 | $190.11 | $190.11 |
- 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 |