- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $515.26 / $2,376.00 / $7,049.79
| Facility | | $515.26 | $2,376.00 | $7,049.79 |
- 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
- $625.25 / $1,574.05 / $1,901.11
| Facility | | $625.25 | $1,574.05 | $1,901.11 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $60.88 / $60.88 / $60.88
| Facility | AS | $60.88 | $60.88 | $60.88 |
- 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 |