- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $2,570.40 / $8,709.64
| Facility | | $1,584.89 | $2,570.40 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $2,238.72 / $3,890.45
| Facility | | $1,584.89 | $2,238.72 | $3,890.45 |
- 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 / $46,773.51 / $46,773.51
| Facility | | $56.23 | $46,773.51 | $46,773.51 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $4,677.35 / $4,677.35 / $4,677.35
| Facility | AS | $4,677.35 | $4,677.35 | $4,677.35 |