- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $5,888.44 / $14,454.40
| Facility | | $1,412.54 | $5,888.44 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $10,000.00 / $18,620.87
| Facility | | $3,715.35 | $10,000.00 | $18,620.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $3,630.78 / $11,481.54
| Facility | | $1,862.09 | $3,630.78 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $186.21 / $186.21 / $186.21
| Facility | AS | $186.21 | $186.21 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $7,244.36 / $16,218.10
| Facility | | $2,511.89 | $7,244.36 | $16,218.10 |