- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $731.91 / $4,853.67 / $9,915.84
| Facility | | $731.91 | $4,853.67 | $9,915.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,473.00 / $7,264.00 / $13,780.00
| Facility | | $3,473.00 | $7,264.00 | $13,780.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $522.65 / $1,244.58 / $3,959.16
| Facility | | $522.65 | $1,244.58 | $3,959.16 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $37.06 / $37.06 / $37.06
| Facility | AS | $37.06 | $37.06 | $37.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,868.50 / $5,742.00 / $11,732.00
| Facility | | $1,868.50 | $5,742.00 | $11,732.00 |