- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.54 / $977.54 / $6,575.00
| Facility | | $977.54 | $977.54 | $6,575.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,088.76 / $4,689.51 / $8,467.59
| Facility | | $2,088.76 | $4,689.51 | $8,467.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,366.38 / $3,357.56 / $8,077.06
| Facility | | $2,366.38 | $3,357.56 | $8,077.06 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $111.81 / $111.81 / $111.81
| Facility | AS | $111.81 | $111.81 | $111.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,151.26 / $3,069.61 / $6,359.89
| Facility | | $2,151.26 | $3,069.61 | $6,359.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.74 / $1,670.83 / $2,932.96
| Facility | | $1,047.74 | $1,670.83 | $2,932.96 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $251.88 / $251.88 / $251.88
| Facility | AS | $251.88 | $251.88 | $251.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,940.00 / $7,872.00 / $11,531.00
| Facility | | $3,940.00 | $7,872.00 | $11,531.00 |