- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $501.19 / $6,760.83
| Facility | | $501.19 | $501.19 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $13,803.84 / $32,359.37
| Facility | | $3,019.95 | $13,803.84 | $32,359.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,862.09 / $4,365.16
| Facility | | $1,318.26 | $1,862.09 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $85.11 / $85.11 / $85.11
| Facility | AS | $85.11 | $85.11 | $85.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $1,778.28 / $3,467.37
| Facility | | $1,412.54 | $1,778.28 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $954.99 / $6,918.31
| Facility | | $501.19 | $954.99 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $5,011.87 / $10,715.19
| Facility | | $2,818.38 | $5,011.87 | $10,715.19 |