- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $4,168.69 / $8,511.38
| Facility | | $1,096.48 | $4,168.69 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $4,677.35 / $10,000.00
| Facility | | $2,238.72 | $4,677.35 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $4,265.80 / $26,302.68
| Facility | | $831.76 | $4,265.80 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $158.49 / $1,621.81 / $1,621.81
| Facility | AS | $158.49 | $1,621.81 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $3,981.07 / $6,918.31
| Facility | | $2,884.03 | $3,981.07 | $6,918.31 |