- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $4,677.35 / $11,220.18
| Facility | | $1,023.29 | $4,677.35 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $5,888.44 / $13,489.63
| Facility | | $2,344.23 | $5,888.44 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $1,949.84 / $5,128.61
| Facility | | $602.56 | $1,949.84 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $125.89 / $125.89 / $125.89
| Facility | AS | $125.89 | $125.89 | $125.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $4,265.80 / $10,000.00
| Facility | | $1,513.56 | $4,265.80 | $10,000.00 |