- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $14,791.08 / $14,791.08
| Facility | | $602.56 | $14,791.08 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $660.69 / $794.33
| Facility | | $660.69 | $660.69 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,047.13 / $1,318.26
| Facility | | $1,047.13 | $1,047.13 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $104.71 / $104.71 / $104.71
| Facility | AS | $104.71 | $104.71 | $104.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $18,197.01 / $37,153.52
| Facility | | $4,466.84 | $18,197.01 | $37,153.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $2,884.03 / $20,417.38
| Facility | | $2,884.03 | $2,884.03 | $20,417.38 |