- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $2,754.23 / $8,912.51
| Facility | | $524.81 | $2,754.23 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $4,570.88 / $13,489.63
| Facility | | $1,621.81 | $4,570.88 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $1,148.15 / $2,691.53
| Facility | | $489.78 | $1,148.15 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $63.10 / $63.10 / $63.10
| Facility | AS | $63.10 | $63.10 | $63.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $4,265.80 / $10,000.00
| Facility | | $1,513.56 | $4,265.80 | $10,000.00 |