- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $5,011.87 / $12,302.69
| Facility | | $1,318.26 | $5,011.87 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $10,715.19 / $24,547.09
| Facility | | $3,548.13 | $10,715.19 | $24,547.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $2,884.03 / $10,000.00
| Facility | | $1,584.89 | $2,884.03 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $158.49 / $158.49 / $158.49
| Facility | AS | $158.49 | $158.49 | $158.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $9,120.11 / $20,892.96
| Facility | | $3,019.95 | $9,120.11 | $20,892.96 |