- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $661.00 / $3,352.04 / $7,466.50
| Facility | | $661.00 | $3,352.04 | $7,466.50 |
- 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
- $726.13 / $1,401.58 / $2,070.38
| Facility | | $726.13 | $1,401.58 | $2,070.38 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $51.49 / $51.49 / $51.49
| Facility | AS | $51.49 | $51.49 | $51.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,200.00 / $5,111.00 / $9,622.00
| Facility | | $2,200.00 | $5,111.00 | $9,622.00 |