- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $6,309.57 / $16,218.10
| Facility | | $1,380.38 | $6,309.57 | $16,218.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $398.11 / $10,000.00
| Facility | | $34.67 | $398.11 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $281.84 / $281.84 / $281.84
| Facility | AS | $281.84 | $281.84 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,332.54 / $20,892.96 / $33,113.11
| Facility | | $9,332.54 | $20,892.96 | $33,113.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $15,488.17 / $27,542.29
| Facility | | $6,165.95 | $15,488.17 | $27,542.29 |