- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $1,949.84 / $8,709.64
| Facility | | $776.25 | $1,949.84 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $954.99 / $1,445.44
| Facility | | $776.25 | $954.99 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $3,890.45 / $6,918.31
| Facility | | $1,174.90 | $3,890.45 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $14,454.40 / $14,454.40
| Facility | | $56.23 | $14,454.40 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,445.44 / $1,445.44 / $1,445.44
| Facility | AS | $1,445.44 | $1,445.44 | $1,445.44 |