- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $262.32 / $3,593.50 / $8,074.63
| Facility | | $262.32 | $3,593.50 | $8,074.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,085.00 / $12,014.00 / $22,154.73
| Facility | | $6,085.00 | $12,014.00 | $22,154.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $330.73 / $330.73 / $908.00
| Facility | | $330.73 | $330.73 | $908.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $23.45 / $23.45 / $23.45
| Facility | AS | $23.45 | $23.45 | $23.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,292.00 / $3,325.00 / $8,198.00
| Facility | | $1,292.00 | $3,325.00 | $8,198.00 |