- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $4,897.79 / $8,511.38
| Facility | | $1,659.59 | $4,897.79 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $4,897.79 / $10,000.00
| Facility | | $2,238.72 | $4,897.79 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.95 / $2,454.71 / $11,481.54
| Facility | | $54.95 | $2,454.71 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $331.13 / $616.60 / $616.60
| Facility | AS | $331.13 | $616.60 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $2,818.38 / $10,471.29
| Facility | | $1,318.26 | $2,818.38 | $10,471.29 |