- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,941.00 / $4,474.00 / $7,133.00
| Facility | | $1,941.00 | $4,474.00 | $7,133.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $830.45 / $3,126.40 / $5,113.62
| Facility | | $830.45 | $3,126.40 | $5,113.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $471.30 / $632.66 / $3,790.00
| Facility | | $471.30 | $632.66 | $3,790.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $126.66 / $126.66 / $849.00
| Facility | AS | $126.66 | $126.66 | $849.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,149.00 / $3,533.00 / $5,546.00
| Facility | | $2,149.00 | $3,533.00 | $5,546.00 |