- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $5,248.07 / $12,589.25
| Facility | | $3,235.94 | $5,248.07 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $4,265.80 / $7,079.46
| Facility | | $3,235.94 | $4,265.80 | $7,079.46 |
- 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 / $77,624.71 / $77,624.71
| Facility | | $56.23 | $77,624.71 | $77,624.71 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $7,762.47 / $7,762.47 / $7,762.47
| Facility | AS | $7,762.47 | $7,762.47 | $7,762.47 |