- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $7,585.78 / $20,417.38
| Facility | | $758.58 | $7,585.78 | $20,417.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $19,952.62 / $47,863.01
| Facility | | $1,905.46 | $19,952.62 | $47,863.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $2,951.21 / $7,079.46
| Facility | | $2,089.30 | $2,951.21 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $141.25 / $141.25 / $141.25
| Facility | AS | $141.25 | $141.25 | $141.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $2,818.38 / $5,623.41
| Facility | | $2,290.87 | $2,818.38 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $4,897.79 / $12,302.69
| Facility | | $1,230.27 | $4,897.79 | $12,302.69 |
- 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 |