- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,170.00 / $2,640.00 / $5,506.00
| Facility | | $1,170.00 | $2,640.00 | $5,506.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $882.30 / $3,321.60 / $5,432.89
| Facility | | $882.30 | $3,321.60 | $5,432.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $890.00 / $1,189.30 / $2,253.87
| Facility | | $890.00 | $1,189.30 | $2,253.87 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $237.65 / $237.65 / $448.09
| Facility | AS | $237.65 | $237.65 | $448.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $716.00 / $1,535.00 / $2,326.00
| Facility | | $716.00 | $1,535.00 | $2,326.00 |