- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $592.06 / $2,593.50 / $7,431.00
| Facility | | $592.06 | $2,593.50 | $7,431.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,456.00 / $7,264.00 / $10,043.00
| Facility | | $2,456.00 | $7,264.00 | $10,043.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $571.54 / $571.54 / $908.00
| Facility | | $571.54 | $571.54 | $908.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $40.53 / $40.53 / $40.53
| Facility | AS | $40.53 | $40.53 | $40.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $444.00 / $1,221.00 / $3,011.00
| Facility | | $444.00 | $1,221.00 | $3,011.00 |