- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $1,659.59 / $8,709.64
| Facility | | $741.31 | $1,659.59 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $1,148.15 / $1,995.26
| Facility | | $741.31 | $1,148.15 | $1,995.26 |
- 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 / $13,803.84 / $13,803.84
| Facility | | $56.23 | $13,803.84 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,380.38 / $1,380.38 / $1,380.38
| Facility | AS | $1,380.38 | $1,380.38 | $1,380.38 |