- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,137.46 / $3,684.00 / $18,600.00
| Facility | | $1,137.46 | $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
- $966.84 / $1,376.33 / $5,415.32
| Facility | | $966.84 | $1,376.33 | $5,415.32 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $479.42 / $479.42 / $479.42
| Facility | AS | $479.42 | $479.42 | $479.42 |
- 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 |