- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $763.86 / $763.86 / $2,525.00
| Facility | | $763.86 | $763.86 | $2,525.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,509.28 / $4,453.10 / $7,808.13
| Facility | | $2,509.28 | $4,453.10 | $7,808.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.90 / $2,704.20 / $6,505.32
| Facility | | $1,905.90 | $2,704.20 | $6,505.32 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $90.56 / $90.56 / $90.56
| Facility | AS | $90.56 | $90.56 | $90.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,732.64 / $2,472.29 / $5,122.30
| Facility | | $1,732.64 | $2,472.29 | $5,122.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $811.49 / $1,346.44 / $4,509.66
| Facility | | $811.49 | $1,346.44 | $4,509.66 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $202.37 / $202.37 / $202.37
| Facility | AS | $202.37 | $202.37 | $202.37 |
- 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 |