- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,095.00 / $3,819.00 / $7,467.00
| Facility | | $2,095.00 | $3,819.00 | $7,467.00 |
- 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
- $1,460.56 / $2,027.77 / $3,978.00
| Facility | | $1,460.56 | $2,027.77 | $3,978.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $392.34 / $392.34 / $717.09
| Facility | AS | $392.34 | $392.34 | $717.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,343.00 / $3,339.00 / $5,838.00
| Facility | | $2,343.00 | $3,339.00 | $5,838.00 |