- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,108.79 / $3,684.00 / $18,600.00
| Facility | | $1,108.79 | $3,684.00 | $18,600.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,281.98 / $8,331.20 / $13,211.85
| Facility | | $5,281.98 | $8,331.20 | $13,211.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $965.86 / $1,413.48 / $4,132.00
| Facility | | $965.86 | $1,413.48 | $4,132.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $524.39 / $524.39 / $524.39
| Facility | AS | $524.39 | $524.39 | $524.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $350.00 / $1,760.00 / $6,155.68
| Facility | | $350.00 | $1,760.00 | $6,155.68 |