- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $3,311.31 / $10,000.00
| Facility | | $660.69 | $3,311.31 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $5,128.61 / $5,370.32
| Facility | | $34.67 | $5,128.61 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $77.62 / $77.62 / $77.62
| Facility | AS | $77.62 | $77.62 | $77.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $12,022.64 / $22,908.68
| Facility | | $6,165.95 | $12,022.64 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $12,882.50 / $20,417.38
| Facility | | $4,365.16 | $12,882.50 | $20,417.38 |