- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $187.06 / $3,593.50 / $8,074.63
| Facility | | $187.06 | $3,593.50 | $8,074.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,503.33 / $8,650.50 / $13,227.00
| Facility | | $4,503.33 | $8,650.50 | $13,227.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.00 / $323.00 / $662.42
| Facility | | $323.00 | $323.00 | $662.42 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $16.48 / $16.48 / $16.48
| Facility | AS | $16.48 | $16.48 | $16.48 |
- 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 |