- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $6,606.93 / $10,471.29
| Facility | | $776.25 | $6,606.93 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $14,125.38 / $32,359.37
| Facility | | $4,570.88 | $14,125.38 | $32,359.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $2,818.38 / $6,760.83
| Facility | | $1,995.26 | $2,818.38 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $131.83 / $131.83 / $131.83
| Facility | AS | $131.83 | $131.83 | $131.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,691.53 / $5,248.07
| Facility | | $2,137.96 | $2,691.53 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $1,584.89 / $10,000.00
| Facility | | $812.83 | $1,584.89 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,168.69 / $7,943.28 / $12,589.25
| Facility | | $4,168.69 | $7,943.28 | $12,589.25 |