- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $4,897.79 / $12,022.64
| Facility | | $1,071.52 | $4,897.79 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $10,000.00 / $20,417.38
| Facility | | $3,467.37 | $10,000.00 | $20,417.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $1,096.48 / $10,000.00
| Facility | | $512.86 | $1,096.48 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $109.65 / $109.65 / $109.65
| Facility | AS | $109.65 | $109.65 | $109.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $6,606.93 / $15,848.93
| Facility | | $1,778.28 | $6,606.93 | $15,848.93 |