- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $3,548.13 / $11,220.18
| Facility | | $2,187.76 | $3,548.13 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $3,311.31 / $5,370.32
| Facility | | $2,187.76 | $3,311.31 | $5,370.32 |
- 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 / $52,480.75 / $52,480.75
| Facility | | $56.23 | $52,480.75 | $52,480.75 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $5,248.07 / $5,248.07 / $5,248.07
| Facility | AS | $5,248.07 | $5,248.07 | $5,248.07 |