- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.24 / $5,223.00 / $5,223.00
| Facility | | $912.24 | $5,223.00 | $5,223.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $638.62 / $706.45 / $769.70
| Facility | | $638.62 | $706.45 | $769.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.52 / $691.52 / $691.52
| Facility | | $691.52 | $691.52 | $691.52 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $69.08 / $69.08 / $69.08
| Facility | AS | $69.08 | $69.08 | $69.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,345.75 / $8,528.87 / $33,284.23
| Facility | | $4,345.75 | $8,528.87 | $33,284.23 |