- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $603.00 / $2,677.98 / $7,162.02
| Facility | | $603.00 | $2,677.98 | $7,162.02 |
- 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
- $714.12 / $1,574.05 / $1,901.11
| Facility | | $714.12 | $1,574.05 | $1,901.11 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $71.41 / $71.41 / $71.41
| Facility | AS | $71.41 | $71.41 | $71.41 |
- 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 |