- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,258.93 / $1,258.93
| Facility | | $1,258.93 | $1,258.93 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,244.36 / $13,489.63 / $26,915.35
| Facility | | $7,244.36 | $13,489.63 | $26,915.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $4,168.69 / $10,000.00
| Facility | | $2,951.21 | $4,168.69 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $208.93 / $208.93 / $208.93
| Facility | AS | $208.93 | $208.93 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $3,981.07 / $7,762.47
| Facility | | $3,162.28 | $3,981.07 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $2,089.30 / $3,981.07
| Facility | | $851.14 | $2,089.30 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $3,467.37 / $8,511.38
| Facility | | $1,584.89 | $3,467.37 | $8,511.38 |