- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $2,238.72 / $8,709.64
| Facility | | $891.25 | $2,238.72 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $1,071.52 / $1,905.46
| Facility | | $758.58 | $1,071.52 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $812.83 / $1,949.84
| Facility | | $363.08 | $812.83 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $26,302.68 / $26,302.68
| Facility | | $56.23 | $26,302.68 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $2,630.27 / $2,630.27 / $2,630.27
| Facility | AS | $2,630.27 | $2,630.27 | $2,630.27 |