- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $321.60 / $2,747.00 / $7,838.38
| Facility | | $321.60 | $2,747.00 | $7,838.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,399.48 / $4,699.53 / $7,874.90
| Facility | | $2,399.48 | $4,699.53 | $7,874.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $409.27 / $409.27 / $632.00
| Facility | | $409.27 | $409.27 | $632.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $29.68 / $29.68 / $29.68
| Facility | AS | $29.68 | $29.68 | $29.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,185.00 / $3,269.00 / $7,384.00
| Facility | | $1,185.00 | $3,269.00 | $7,384.00 |