- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $3,715.35 / $8,912.51
| Facility | | $2,290.87 | $3,715.35 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $3,235.94 / $5,623.41
| Facility | | $2,290.87 | $3,235.94 | $5,623.41 |
- 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 / $54,954.09 / $54,954.09
| Facility | | $56.23 | $54,954.09 | $54,954.09 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $5,495.41 / $5,495.41 / $5,495.41
| Facility | AS | $5,495.41 | $5,495.41 | $5,495.41 |