- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,170.00 / $2,292.00 / $5,506.00
| Facility | | $1,170.00 | $2,292.00 | $5,506.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $438.60 / $1,704.86 / $2,700.74
| Facility | | $438.60 | $1,704.86 | $2,700.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $790.06 / $1,075.99 / $16,484.00
| Facility | | $790.06 | $1,075.99 | $16,484.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $210.38 / $210.38 / $1,045.32
| Facility | AS | $210.38 | $210.38 | $1,045.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,878.00 / $6,336.00 / $17,057.00
| Facility | | $2,878.00 | $6,336.00 | $17,057.00 |