- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $2,137.96 / $8,709.64
| Facility | | $1,288.25 | $2,137.96 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,995.26 / $3,548.13
| Facility | | $1,288.25 | $1,995.26 | $3,548.13 |
- 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 / $12,882.50 / $12,882.50
| Facility | | $56.23 | $12,882.50 | $12,882.50 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,288.25 / $1,288.25 / $1,288.25
| Facility | AS | $1,288.25 | $1,288.25 | $1,288.25 |