- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $350.26 / $2,892.50 / $7,879.32
| Facility | | $350.26 | $2,892.50 | $7,879.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,381.00 / $4,699.53 / $8,086.09
| Facility | | $2,381.00 | $4,699.53 | $8,086.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $430.82 / $430.82 / $632.00
| Facility | | $430.82 | $430.82 | $632.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $32.72 / $32.72 / $32.72
| Facility | AS | $32.72 | $32.72 | $32.72 |
- 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 |