- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $3,981.07 / $10,000.00
| Facility | | $776.25 | $3,981.07 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $457.09 / $2,630.27
| Facility | | $323.59 | $457.09 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $144.54 / $144.54 / $144.54
| Facility | AS | $144.54 | $144.54 | $144.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,456.54 / $19,498.45 / $32,359.37
| Facility | | $6,456.54 | $19,498.45 | $32,359.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $3,388.44 / $6,606.93
| Facility | | $707.95 | $3,388.44 | $6,606.93 |