- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $5,370.32 / $12,882.50
| Facility | | $1,096.48 | $5,370.32 | $12,882.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $11,220.18 / $26,302.68
| Facility | | $3,715.35 | $11,220.18 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $2,344.23 / $10,000.00
| Facility | | $1,174.90 | $2,344.23 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $117.49 / $117.49 / $117.49
| Facility | AS | $117.49 | $117.49 | $117.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $11,481.54 / $27,542.29
| Facility | | $3,715.35 | $11,481.54 | $27,542.29 |