- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $5,011.87 / $12,022.64
| Facility | | $954.99 | $5,011.87 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $10,000.00 / $18,620.87
| Facility | | $3,630.78 | $10,000.00 | $18,620.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $1,819.70 / $4,570.88
| Facility | | $851.14 | $1,819.70 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $89.13 / $89.13 / $89.13
| Facility | AS | $89.13 | $89.13 | $89.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $5,754.40 / $13,182.57
| Facility | | $1,995.26 | $5,754.40 | $13,182.57 |