- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $5,248.07 / $15,848.93
| Facility | | $851.14 | $5,248.07 | $15,848.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $1,258.93 / $3,019.95
| Facility | | $489.78 | $1,258.93 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $70.79 / $70.79 / $70.79
| Facility | AS | $70.79 | $70.79 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $11,748.98 / $22,908.68
| Facility | | $5,495.41 | $11,748.98 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $10,000.00 / $15,848.93
| Facility | | $2,818.38 | $10,000.00 | $15,848.93 |