- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $718.56 / $4,159.52 / $9,361.58
| Facility | | $718.56 | $4,159.52 | $9,361.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,302.10 / $5,965.00 / $13,758.00
| Facility | | $3,302.10 | $5,965.00 | $13,758.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $867.57 / $1,732.57 / $2,545.78
| Facility | | $867.57 | $1,732.57 | $2,545.78 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $61.52 / $61.52 / $61.52
| Facility | AS | $61.52 | $61.52 | $61.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,200.00 / $5,111.00 / $9,622.00
| Facility | | $2,200.00 | $5,111.00 | $9,622.00 |