- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $278.73 / $3,606.50 / $8,074.63
| Facility | | $278.73 | $3,606.50 | $8,074.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,317.38 / $2,804.91 / $9,381.00
| Facility | | $1,317.38 | $2,804.91 | $9,381.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.00 / $323.00 / $825.47
| Facility | | $323.00 | $323.00 | $825.47 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $20.28 / $20.28 / $20.28
| Facility | AS | $20.28 | $20.28 | $20.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,342.00 / $3,309.00 / $7,255.00
| Facility | | $1,342.00 | $3,309.00 | $7,255.00 |