- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $221.67 / $2,321.33 / $7,309.86
| Facility | | $221.67 | $2,321.33 | $7,309.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,691.00 / $2,971.00 / $4,707.00
| Facility | | $1,691.00 | $2,971.00 | $4,707.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $120.82 / $120.82 / $120.82
| Facility | | $120.82 | $120.82 | $120.82 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $11.78 / $11.78 / $11.78
| Facility | AS | $11.78 | $11.78 | $11.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $367.00 / $1,189.50 / $2,726.50
| Facility | | $367.00 | $1,189.50 | $2,726.50 |