- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $854.97 / $3,965.50 / $8,181.00
| Facility | | $854.97 | $3,965.50 | $8,181.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,452.00 / $7,264.00 / $12,538.00
| Facility | | $4,452.00 | $7,264.00 | $12,538.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $814.57 / $814.57 / $3,396.95
| Facility | | $814.57 | $814.57 | $3,396.95 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $65.23 / $65.23 / $65.23
| Facility | AS | $65.23 | $65.23 | $65.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,062.00 / $8,273.00 / $14,705.00
| Facility | | $4,062.00 | $8,273.00 | $14,705.00 |