- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $821.50 / $2,303.00 / $7,850.63
| Facility | | $821.50 | $2,303.00 | $7,850.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,816.00 / $9,314.00 / $16,534.00
| Facility | | $2,816.00 | $9,314.00 | $16,534.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,892.37 / $12,000.00 / $98,066.20
| Facility | | $4,892.37 | $12,000.00 | $98,066.20 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $195.25 / $9,295.29 / $9,295.29
| Facility | AS | $195.25 | $9,295.29 | $9,295.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,029.00 / $11,932.00 / $23,657.00
| Facility | | $5,029.00 | $11,932.00 | $23,657.00 |