- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $1,995.26 / $9,332.54
| Facility | | $912.01 | $1,995.26 | $9,332.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $4,073.80 / $9,549.93
| Facility | | $2,570.40 | $4,073.80 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $1,348.96 / $1,737.80
| Facility | | $977.24 | $1,348.96 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $1,862.09 / $2,290.87
| Facility | | $1,862.09 | $1,862.09 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $186.21 / $186.21 / $186.21
| Facility | AS | $186.21 | $186.21 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $5,011.87 / $12,302.69
| Facility | | $977.24 | $5,011.87 | $12,302.69 |