- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $6,309.57 / $8,912.51
| Facility | | $912.01 | $6,309.57 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $20,417.38 / $47,863.01
| Facility | | $5,495.41 | $20,417.38 | $47,863.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $3,235.94 / $7,585.78
| Facility | | $2,290.87 | $3,235.94 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $151.36 / $151.36 / $151.36
| Facility | AS | $151.36 | $151.36 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $3,090.30 / $6,025.60
| Facility | | $2,454.71 | $3,090.30 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,819.70 / $12,022.64
| Facility | | $1,202.26 | $1,819.70 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,888.44 / $10,000.00 / $26,915.35
| Facility | | $5,888.44 | $10,000.00 | $26,915.35 |