- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $266.98 / $3,113.50 / $8,074.63
| Facility | | $266.98 | $3,113.50 | $8,074.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,302.10 / $4,814.00 / $10,517.23
| Facility | | $3,302.10 | $4,814.00 | $10,517.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $486.83 / $550.00 / $981.73
| Facility | | $486.83 | $550.00 | $981.73 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $23.94 / $23.94 / $23.94
| Facility | AS | $23.94 | $23.94 | $23.94 |
- 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 |