- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $5,888.44 / $8,709.64
| Facility | | $1,659.59 | $5,888.44 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $2,818.38 / $4,897.79
| Facility | | $1,995.26 | $2,818.38 | $4,897.79 |
- 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 / $56,234.13 / $56,234.13
| Facility | | $56.23 | $56,234.13 | $56,234.13 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $5,623.41 / $5,623.41 / $5,623.41
| Facility | AS | $5,623.41 | $5,623.41 | $5,623.41 |