- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $472.21 / $472.21 / $2,300.00
| Facility | | $472.21 | $472.21 | $2,300.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $488.28 / $550.91 / $600.24
| Facility | | $488.28 | $550.91 | $600.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $521.29 / $521.29 / $521.29
| Facility | | $521.29 | $521.29 | $521.29 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $51.75 / $51.75 / $51.75
| Facility | AS | $51.75 | $51.75 | $51.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,450.00 / $2,450.00 / $2,450.00
| Facility | | $2,450.00 | $2,450.00 | $2,450.00 |