- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $848.64 / $4,230.48 / $9,681.72
| Facility | | $848.64 | $4,230.48 | $9,681.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,302.10 / $5,196.00 / $11,433.00
| Facility | | $3,302.10 | $5,196.00 | $11,433.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,005.16 / $1,574.05 / $2,172.58
| Facility | | $1,005.16 | $1,574.05 | $2,172.58 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $67.11 / $67.11 / $67.11
| Facility | AS | $67.11 | $67.11 | $67.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,200.00 / $5,111.00 / $9,202.00
| Facility | | $2,200.00 | $5,111.00 | $9,202.00 |