- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $2,951.21 / $8,709.64
| Facility | | $1,819.70 | $2,951.21 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $2,511.89 / $3,890.45
| Facility | | $1,819.70 | $2,511.89 | $3,890.45 |
- 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 / $25,703.96 / $25,703.96
| Facility | | $56.23 | $25,703.96 | $25,703.96 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $2,570.40 / $2,570.40 / $2,570.40
| Facility | AS | $2,570.40 | $2,570.40 | $2,570.40 |