- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $701.20 / $3,038.00 / $7,212.00
| Facility | | $701.20 | $3,038.00 | $7,212.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,248.00 / $5,196.00 / $10,517.23
| Facility | | $3,248.00 | $5,196.00 | $10,517.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $725.00 / $1,483.72 / $1,901.11
| Facility | | $725.00 | $1,483.72 | $1,901.11 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $55.10 / $55.10 / $55.10
| Facility | AS | $55.10 | $55.10 | $55.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,832.00 / $3,764.00 / $7,934.00
| Facility | | $1,832.00 | $3,764.00 | $7,934.00 |