- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $949.42 / $3,606.50 / $8,074.63
| Facility | | $949.42 | $3,606.50 | $8,074.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,470.00 / $9,458.00 / $17,400.00
| Facility | | $5,470.00 | $9,458.00 | $17,400.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $937.50 / $937.50 / $2,361.86
| Facility | | $937.50 | $937.50 | $2,361.86 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $85.04 / $85.04 / $85.04
| Facility | AS | $85.04 | $85.04 | $85.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,403.00 / $3,325.00 / $8,152.00
| Facility | | $1,403.00 | $3,325.00 | $8,152.00 |