- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $873.00 / $3,864.07 / $8,828.00
| Facility | | $873.00 | $3,864.07 | $8,828.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,248.00 / $5,196.00 / $11,909.00
| Facility | | $3,248.00 | $5,196.00 | $11,909.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,034.77 / $1,967.06 / $4,980.18
| Facility | | $1,034.77 | $1,967.06 | $4,980.18 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $73.37 / $73.37 / $73.37
| Facility | AS | $73.37 | $73.37 | $73.37 |
- 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 |