- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,441.15 / $5,150.39 / $22,365.00
| Facility | | $1,441.15 | $5,150.39 | $22,365.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,512.00 / $7,138.00 / $13,623.00
| Facility | | $3,512.00 | $7,138.00 | $13,623.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,242.09 / $27,770.10 / $27,770.10
| Facility | | $5,242.09 | $27,770.10 | $27,770.10 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $205.25 / $2,632.21 / $2,632.21
| Facility | AS | $205.25 | $2,632.21 | $2,632.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,964.00 / $8,273.00 / $12,407.00
| Facility | | $3,964.00 | $8,273.00 | $12,407.00 |