- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,088.47 / $3,683.00 / $18,600.00
| Facility | | $1,088.47 | $3,683.00 | $18,600.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,951.01 / $9,242.51 / $14,465.62
| Facility | | $5,951.01 | $9,242.51 | $14,465.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $925.30 / $1,341.69 / $4,132.00
| Facility | | $925.30 | $1,341.69 | $4,132.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $458.54 / $458.54 / $458.54
| Facility | AS | $458.54 | $458.54 | $458.54 |
- 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 |