- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,070.00 / $2,304.00 / $5,506.00
| Facility | | $1,070.00 | $2,304.00 | $5,506.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $438.60 / $1,651.20 / $2,700.74
| Facility | | $438.60 | $1,651.20 | $2,700.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $710.86 / $961.65 / $6,063.00
| Facility | | $710.86 | $961.65 | $6,063.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $192.10 / $192.10 / $849.00
| Facility | AS | $192.10 | $192.10 | $849.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,892.00 / $4,545.00 / $7,217.00
| Facility | | $2,892.00 | $4,545.00 | $7,217.00 |