- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,778.28 / $8,709.64
| Facility | | $1,096.48 | $1,778.28 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,548.82 / $2,398.83
| Facility | | $1,096.48 | $1,548.82 | $2,398.83 |
- 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 / $16,218.10 / $16,218.10
| Facility | | $56.23 | $16,218.10 | $16,218.10 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,621.81 / $1,621.81 / $1,621.81
| Facility | AS | $1,621.81 | $1,621.81 | $1,621.81 |