- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $882.00 / $4,641.84 / $9,823.00
| Facility | | $882.00 | $4,641.84 | $9,823.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,452.00 / $7,363.00 / $12,274.00
| Facility | | $4,452.00 | $7,363.00 | $12,274.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.25 / $2,344.25 / $3,088.67
| Facility | | $2,344.25 | $2,344.25 | $3,088.67 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $59.84 / $59.84 / $59.84
| Facility | AS | $59.84 | $59.84 | $59.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,637.00 / $5,735.00 / $9,622.00
| Facility | | $2,637.00 | $5,735.00 | $9,622.00 |