- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $711.00 / $3,520.00 / $7,996.00
| Facility | | $711.00 | $3,520.00 | $7,996.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,248.00 / $5,196.00 / $11,136.00
| Facility | | $3,248.00 | $5,196.00 | $11,136.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $796.06 / $1,529.00 / $2,070.38
| Facility | | $796.06 | $1,529.00 | $2,070.38 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $56.45 / $56.45 / $56.45
| Facility | AS | $56.45 | $56.45 | $56.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,200.00 / $5,111.00 / $9,202.00
| Facility | | $2,200.00 | $5,111.00 | $9,202.00 |