- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $3,311.31 / $10,000.00
| Facility | | $977.24 | $3,311.31 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $6,606.93 / $14,125.38
| Facility | | $3,090.30 | $6,606.93 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $2,238.72 / $7,079.46
| Facility | | $812.83 | $2,238.72 | $7,079.46 |
- 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
- $1,905.46 / $5,754.40 / $14,454.40
| Facility | | $1,905.46 | $5,754.40 | $14,454.40 |