- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,435.57 / $4,161.00 / $10,746.00
| Facility | | $1,435.57 | $4,161.00 | $10,746.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,276.00 / $6,223.00 / $9,283.00
| Facility | | $3,276.00 | $6,223.00 | $9,283.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,091.42 / $15,214.55 / $26,542.00
| Facility | | $5,091.42 | $15,214.55 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $225.48 / $1,442.13 / $1,442.13
| Facility | AS | $225.48 | $1,442.13 | $1,442.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,799.00 / $5,728.00 / $10,111.00
| Facility | | $2,799.00 | $5,728.00 | $10,111.00 |