- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $409.92 / $1,400.00 / $18,112.75
| Facility | | $409.92 | $1,400.00 | $18,112.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $405.77 / $440.34 / $530.51
| Facility | | $405.77 | $440.34 | $530.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $473.24 / $473.24 / $473.24
| Facility | | $473.24 | $473.24 | $473.24 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $47.01 / $47.01 / $47.01
| Facility | AS | $47.01 | $47.01 | $47.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,967.06 / $4,967.06 / $4,967.06
| Facility | | $4,967.06 | $4,967.06 | $4,967.06 |