- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $3,715.35 / $9,332.54
| Facility | | $1,258.93 | $3,715.35 | $9,332.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $4,677.35 / $9,549.93
| Facility | | $2,238.72 | $4,677.35 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $1,698.24 / $21,379.62
| Facility | | $954.99 | $1,698.24 | $21,379.62 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $269.15 / $1,905.46 / $1,905.46
| Facility | AS | $269.15 | $1,905.46 | $1,905.46 |
- 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 |