- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $2,691.53 / $7,585.78
| Facility | | $2,398.83 | $2,691.53 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $2,454.71 / $5,623.41
| Facility | | $1,258.93 | $2,454.71 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.95 / $33,884.42 / $33,884.42
| Facility | | $54.95 | $33,884.42 | $33,884.42 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $3,388.44 / $3,388.44 / $3,388.44
| Facility | AS | $3,388.44 | $3,388.44 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $2,630.27 / $4,786.30
| Facility | | $1,258.93 | $2,630.27 | $4,786.30 |