- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $787.00 / $1,202.70 / $2,747.00
| Facility | | $787.00 | $1,202.70 | $2,747.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,643.00 / $3,498.00 / $8,517.00
| Facility | | $1,643.00 | $3,498.00 | $8,517.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $874.23 / $1,260.81 / $1,454.43
| Facility | | $874.23 | $1,260.81 | $1,454.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,102.93 / $1,102.93 / $1,184.27
| Facility | | $1,102.93 | $1,102.93 | $1,184.27 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $109.46 / $109.46 / $109.46
| Facility | AS | $109.46 | $109.46 | $109.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $842.00 / $4,539.00 / $10,113.00
| Facility | | $842.00 | $4,539.00 | $10,113.00 |