- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $4,365.16 / $8,709.64
| Facility | | $2,089.30 | $4,365.16 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $2,238.72 / $3,630.78
| Facility | | $630.96 | $2,238.72 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $977.24 / $10,000.00
| Facility | | $660.69 | $977.24 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $186.21 / $186.21 / $2,454.71
| Facility | AS | $186.21 | $186.21 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $7,079.46 / $10,964.78
| Facility | | $5,495.41 | $7,079.46 | $10,964.78 |