- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.75 / $6,446.00 / $22,789.85
| Facility | | $1,698.75 | $6,446.00 | $22,789.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,512.00 / $7,178.00 / $13,623.00
| Facility | | $3,512.00 | $7,178.00 | $13,623.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,889.10 / $27,770.10 / $27,770.10
| Facility | | $5,889.10 | $27,770.10 | $27,770.10 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $230.68 / $2,632.21 / $2,632.21
| Facility | AS | $230.68 | $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 |