- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.07 / $2,846.50 / $7,288.50
| Facility | | $691.07 | $2,846.50 | $7,288.50 |
- 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 / $1,525.84 / $1,901.11
| Facility | | $725.00 | $1,525.84 | $1,901.11 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $56.11 / $56.11 / $56.11
| Facility | AS | $56.11 | $56.11 | $56.11 |
- 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 |