- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $810.41 / $810.41 / $6,781.00
| Facility | | $810.41 | $810.41 | $6,781.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,088.76 / $4,232.33 / $7,058.25
| Facility | | $2,088.76 | $4,232.33 | $7,058.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,966.51 / $2,790.20 / $6,712.20
| Facility | | $1,966.51 | $2,790.20 | $6,712.20 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $92.05 / $92.05 / $92.05
| Facility | AS | $92.05 | $92.05 | $92.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,787.74 / $2,550.91 / $5,285.20
| Facility | | $1,787.74 | $2,550.91 | $5,285.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $840.57 / $1,388.00 / $4,282.20
| Facility | | $840.57 | $1,388.00 | $4,282.20 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $209.10 / $209.10 / $209.10
| Facility | AS | $209.10 | $209.10 | $209.10 |
- 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 |