- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,016.77 / $2,678.00 / $7,602.00
| Facility | | $1,016.77 | $2,678.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,465.00 / $9,265.00 / $16,534.00
| Facility | | $2,465.00 | $9,265.00 | $16,534.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,980.08 / $26,542.00 / $97,992.80
| Facility | | $2,980.08 | $26,542.00 | $97,992.80 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $207.72 / $9,288.33 / $9,288.33
| Facility | AS | $207.72 | $9,288.33 | $9,288.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,029.00 / $12,981.00 / $27,144.00
| Facility | | $5,029.00 | $12,981.00 | $27,144.00 |