- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $4,897.79 / $8,511.38
| Facility | | $1,230.27 | $4,897.79 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $4,677.35 / $10,000.00
| Facility | | $2,238.72 | $4,677.35 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.95 / $2,187.76 / $12,882.50
| Facility | | $54.95 | $2,187.76 | $12,882.50 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $239.88 / $1,318.26 / $1,318.26
| Facility | AS | $239.88 | $1,318.26 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $3,981.07 / $10,000.00
| Facility | | $2,884.03 | $3,981.07 | $10,000.00 |