- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $3,890.45 / $10,715.19
| Facility | | $776.25 | $3,890.45 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $7,079.46 / $14,454.40
| Facility | | $2,754.23 | $7,079.46 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $1,621.81 / $5,370.32
| Facility | | $707.95 | $1,621.81 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $91.20 / $91.20 / $91.20
| Facility | AS | $91.20 | $91.20 | $91.20 |
- 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 |