- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,120.47 / $3,684.00 / $18,600.00
| Facility | | $1,120.47 | $3,684.00 | $18,600.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,858.92 / $9,241.20 / $14,654.94
| Facility | | $5,858.92 | $9,241.20 | $14,654.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $953.47 / $1,374.67 / $4,132.00
| Facility | | $953.47 | $1,374.67 | $4,132.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $473.22 / $473.22 / $473.22
| Facility | AS | $473.22 | $473.22 | $473.22 |
- 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 |