- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $356.37 / $2,381.50 / $7,279.50
| Facility | | $356.37 | $2,381.50 | $7,279.50 |
- 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
- $361.50 / $453.50 / $640.60
| Facility | | $361.50 | $453.50 | $640.60 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $20.47 / $20.47 / $20.47
| Facility | AS | $20.47 | $20.47 | $20.47 |
- 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 |