- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $846.22 / $3,576.00 / $7,500.00
| Facility | | $846.22 | $3,576.00 | $7,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,977.92 / $18,931.83 / $30,144.09
| Facility | | $11,977.92 | $18,931.83 | $30,144.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $860.69 / $1,655.77 / $23,845.11
| Facility | | $860.69 | $1,655.77 | $23,845.11 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $9,295.29 / $9,295.29 / $9,295.29
| Facility | AS | $9,295.29 | $9,295.29 | $9,295.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,412.00 / $14,511.00 / $24,508.10
| Facility | | $3,412.00 | $14,511.00 | $24,508.10 |