- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,862.09 / $8,709.64
| Facility | | $1,174.90 | $1,862.09 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $1,230.27 / $2,089.30
| Facility | | $891.25 | $1,230.27 | $2,089.30 |
- 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 / $21,877.62 / $21,877.62
| Facility | | $56.23 | $21,877.62 | $21,877.62 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $2,187.76 / $2,187.76 / $2,187.76
| Facility | AS | $2,187.76 | $2,187.76 | $2,187.76 |