- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $2,454.71 / $6,456.54
| Facility | | $812.83 | $2,454.71 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $7,943.28 / $13,489.63
| Facility | | $2,454.71 | $7,943.28 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $794.33 / $794.33
| Facility | | $794.33 | $794.33 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.95 / $13,489.63 / $13,489.63
| Facility | | $54.95 | $13,489.63 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,348.96 / $1,348.96 / $1,348.96
| Facility | AS | $1,348.96 | $1,348.96 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $5,754.40 / $10,232.93
| Facility | | $3,235.94 | $5,754.40 | $10,232.93 |