- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,210.03 / $2,800.00 / $9,039.70
| Facility | | $1,210.03 | $2,800.00 | $9,039.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,367.00 / $5,434.00 / $9,419.00
| Facility | | $2,367.00 | $5,434.00 | $9,419.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,562.74 / $15,214.55 / $26,542.00
| Facility | | $6,562.74 | $15,214.55 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $298.26 / $1,442.13 / $1,442.13
| Facility | AS | $298.26 | $1,442.13 | $1,442.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,905.00 / $5,728.00 / $10,104.00
| Facility | | $2,905.00 | $5,728.00 | $10,104.00 |