- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,004.65 / $2,678.00 / $13,324.90
| Facility | | $1,004.65 | $2,678.00 | $13,324.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,330.00 / $7,266.00 / $13,623.00
| Facility | | $2,330.00 | $7,266.00 | $13,623.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,857.72 / $16,394.00 / $60,555.25
| Facility | | $4,857.72 | $16,394.00 | $60,555.25 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $193.68 / $5,739.78 / $5,739.78
| Facility | AS | $193.68 | $5,739.78 | $5,739.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,850.00 / $10,498.00 / $20,696.00
| Facility | | $6,850.00 | $10,498.00 | $20,696.00 |