- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.73 / $4,285.05 / $9,228.93
| Facility | | $851.73 | $4,285.05 | $9,228.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,403.00 / $6,548.00 / $13,536.00
| Facility | | $3,403.00 | $6,548.00 | $13,536.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,040.50 / $1,694.13 / $2,552.35
| Facility | | $1,040.50 | $1,694.13 | $2,552.35 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $56.48 / $56.48 / $56.48
| Facility | AS | $56.48 | $56.48 | $56.48 |
- 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 |