- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $3,090.30 / $10,000.00
| Facility | | $851.14 | $3,090.30 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $8,317.64 / $16,218.10
| Facility | | $2,754.23 | $8,317.64 | $16,218.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $1,905.46 / $9,772.37
| Facility | | $724.44 | $1,905.46 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $128.82 / $128.82 / $128.82
| Facility | AS | $128.82 | $128.82 | $128.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $8,511.38 / $21,379.62
| Facility | | $2,884.03 | $8,511.38 | $21,379.62 |