- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $4,466.84 / $10,000.00
| Facility | | $1,548.82 | $4,466.84 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $4,677.35 / $8,912.51
| Facility | | $2,238.72 | $4,677.35 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $1,479.11 / $26,302.68
| Facility | | $812.83 | $1,479.11 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $223.87 / $4,677.35 / $4,677.35
| Facility | AS | $223.87 | $4,677.35 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $4,265.80 / $11,481.54
| Facility | | $2,884.03 | $4,265.80 | $11,481.54 |