- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $5,370.32 / $13,489.63
| Facility | | $1,148.15 | $5,370.32 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $10,000.00 / $20,417.38
| Facility | | $3,630.78 | $10,000.00 | $20,417.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $2,187.76 / $10,715.19
| Facility | | $691.83 | $2,187.76 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $125.89 / $125.89 / $125.89
| Facility | AS | $125.89 | $125.89 | $125.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $8,709.64 / $18,620.87
| Facility | | $3,019.95 | $8,709.64 | $18,620.87 |