- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $4,466.84 / $8,511.38
| Facility | | $1,698.24 | $4,466.84 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $4,677.35 / $8,912.51
| Facility | | $2,238.72 | $4,677.35 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $1,258.93 / $25,118.86
| Facility | | $724.44 | $1,258.93 | $25,118.86 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $204.17 / $2,398.83 / $2,398.83
| Facility | AS | $204.17 | $2,398.83 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $4,265.80 / $10,000.00
| Facility | | $2,884.03 | $4,265.80 | $10,000.00 |