- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,343.33 / $2,940.00 / $19,870.00
| Facility | | $1,343.33 | $2,940.00 | $19,870.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,146.00 / $7,266.00 / $13,734.00
| Facility | | $3,146.00 | $7,266.00 | $13,734.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,373.97 / $27,770.10 / $27,770.10
| Facility | | $5,373.97 | $27,770.10 | $27,770.10 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $210.48 / $2,632.21 / $2,632.21
| Facility | AS | $210.48 | $2,632.21 | $2,632.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,238.00 / $7,695.00 / $12,467.00
| Facility | | $4,238.00 | $7,695.00 | $12,467.00 |