- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $2,290.87 / $7,585.78
| Facility | | $575.44 | $2,290.87 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $6,606.93 / $9,772.37
| Facility | | $1,862.09 | $6,606.93 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.20 / $30.20 / $30.20
| Facility | | $30.20 | $30.20 | $30.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.95 / $29,512.09 / $29,512.09
| Facility | | $54.95 | $29,512.09 | $29,512.09 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $2,951.21 / $2,951.21 / $2,951.21
| Facility | AS | $2,951.21 | $2,951.21 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,265.80 / $7,943.28 / $11,481.54
| Facility | | $4,265.80 | $7,943.28 | $11,481.54 |