- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $381.39 / $1,400.00 / $10,042.14
| Facility | | $381.39 | $1,400.00 | $10,042.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.74 / $451.43 / $491.83
| Facility | | $398.74 | $451.43 | $491.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $427.39 / $427.39 / $427.39
| Facility | | $427.39 | $427.39 | $427.39 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $42.13 / $42.13 / $42.13
| Facility | AS | $42.13 | $42.13 | $42.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,731.75 / $5,140.01 / $13,510.49
| Facility | | $2,731.75 | $5,140.01 | $13,510.49 |