- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $4,466.84 / $8,709.64
| Facility | | $933.25 | $4,466.84 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $4,897.79 / $10,000.00
| Facility | | $2,238.72 | $4,897.79 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $3,090.30 / $26,302.68
| Facility | | $724.44 | $3,090.30 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $190.55 / $1,548.82 / $1,548.82
| Facility | AS | $190.55 | $1,548.82 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $3,715.35 / $6,918.31
| Facility | | $2,454.71 | $3,715.35 | $6,918.31 |