- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $3,162.28 / $8,709.64
| Facility | | $1,949.84 | $3,162.28 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $2,630.27 / $4,073.80
| Facility | | $1,949.84 | $2,630.27 | $4,073.80 |
- 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 / $27,542.29 / $27,542.29
| Facility | | $56.23 | $27,542.29 | $27,542.29 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $2,754.23 / $2,754.23 / $2,754.23
| Facility | AS | $2,754.23 | $2,754.23 | $2,754.23 |