- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,070.00 / $2,640.00 / $5,982.25
| Facility | | $1,070.00 | $2,640.00 | $5,982.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $472.60 / $1,768.08 / $2,910.10
| Facility | | $472.60 | $1,768.08 | $2,910.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $221.28 / $320.86 / $1,689.00
| Facility | | $221.28 | $320.86 | $1,689.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $54.80 / $107.63 / $107.63
| Facility | AS | $54.80 | $107.63 | $107.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $704.00 / $1,535.00 / $2,175.00
| Facility | | $704.00 | $1,535.00 | $2,175.00 |