- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $4,265.80 / $10,232.93
| Facility | | $2,691.53 | $4,265.80 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $3,630.78 / $5,623.41
| Facility | | $2,691.53 | $3,630.78 | $5,623.41 |
- 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 / $37,153.52 / $37,153.52
| Facility | | $56.23 | $37,153.52 | $37,153.52 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $3,715.35 / $3,715.35 / $3,715.35
| Facility | AS | $3,715.35 | $3,715.35 | $3,715.35 |