- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $352.51 / $3,113.50 / $8,074.63
| Facility | | $352.51 | $3,113.50 | $8,074.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,393.00 / $4,516.99 / $8,187.38
| Facility | | $2,393.00 | $4,516.99 | $8,187.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.40 / $446.40 / $908.00
| Facility | | $446.40 | $446.40 | $908.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $31.65 / $31.65 / $31.65
| Facility | AS | $31.65 | $31.65 | $31.65 |
- 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 |