- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.30 / $3,124.50 / $7,879.32
| Facility | | $177.30 | $3,124.50 | $7,879.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,476.90 / $7,979.00 / $13,400.83
| Facility | | $3,476.90 | $7,979.00 | $13,400.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $160.57 / $541.00 / $998.00
| Facility | | $160.57 | $541.00 | $998.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $15.62 / $15.62 / $15.62
| Facility | AS | $15.62 | $15.62 | $15.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $718.00 / $2,575.00 / $7,326.50
| Facility | | $718.00 | $2,575.00 | $7,326.50 |