- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $4,365.16 / $10,000.00
| Facility | | $933.25 | $4,365.16 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $1,202.26 / $1,412.54
| Facility | | $34.67 | $1,202.26 | $1,412.54 |
- 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
- $4,365.16 / $8,317.64 / $16,595.87
| Facility | | $4,365.16 | $8,317.64 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $5,623.41 / $9,772.37
| Facility | | $1,905.46 | $5,623.41 | $9,772.37 |