- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,070.00 / $3,477.00 / $7,467.00
| Facility | | $1,070.00 | $3,477.00 | $7,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $672.35 / $2,531.19 / $4,140.09
| Facility | | $672.35 | $2,531.19 | $4,140.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $490.93 / $648.78 / $3,790.00
| Facility | | $490.93 | $648.78 | $3,790.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $131.75 / $131.75 / $497.27
| Facility | AS | $131.75 | $131.75 | $497.27 |
- 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 |