- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $2,137.96 / $27,542.29
| Facility | | $1,288.25 | $2,137.96 | $27,542.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $1,258.93 / $2,089.30
| Facility | | $870.96 | $1,258.93 | $2,089.30 |
- 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 / $15,848.93 / $15,848.93
| Facility | | $56.23 | $15,848.93 | $15,848.93 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,584.89 / $1,584.89 / $1,584.89
| Facility | AS | $1,584.89 | $1,584.89 | $1,584.89 |