- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $212.02 / $3,835.07 / $8,988.50
| Facility | | $212.02 | $3,835.07 | $8,988.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,671.00 / $7,613.00 / $13,747.00
| Facility | | $3,671.00 | $7,613.00 | $13,747.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $351.85 / $437.98 / $954.00
| Facility | | $351.85 | $437.98 | $954.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $18.82 / $18.82 / $18.82
| Facility | AS | $18.82 | $18.82 | $18.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,403.00 / $3,325.00 / $8,198.00
| Facility | | $1,403.00 | $3,325.00 | $8,198.00 |