- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $4,570.88 / $11,481.54
| Facility | | $851.14 | $4,570.88 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $7,943.28 / $16,982.44
| Facility | | $3,235.94 | $7,943.28 | $16,982.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $1,548.82 / $4,677.35
| Facility | | $398.11 | $1,548.82 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | AS | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $8,709.64 / $18,620.87
| Facility | | $3,019.95 | $8,709.64 | $18,620.87 |