- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $293.47 / $2,106.50 / $6,834.50
| Facility | | $293.47 | $2,106.50 | $6,834.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,385.00 / $5,617.00 / $9,074.00
| Facility | | $2,385.00 | $5,617.00 | $9,074.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $348.80 / $434.30 / $640.60
| Facility | | $348.80 | $434.30 | $640.60 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $18.57 / $18.57 / $18.57
| Facility | AS | $18.57 | $18.57 | $18.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,200.00 / $5,111.00 / $9,475.00
| Facility | | $2,200.00 | $5,111.00 | $9,475.00 |