- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $834.92 / $5,006.24 / $6,814.20
| Facility | | $834.92 | $5,006.24 | $6,814.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,578.29 / $6,420.95 / $12,697.20
| Facility | | $3,578.29 | $6,420.95 | $12,697.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,032.18 / $2,883.37 / $6,936.33
| Facility | | $2,032.18 | $2,883.37 | $6,936.33 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $94.40 / $94.40 / $94.40
| Facility | AS | $94.40 | $94.40 | $94.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,847.43 / $2,636.09 / $5,461.68
| Facility | | $1,847.43 | $2,636.09 | $5,461.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $846.23 / $1,520.52 / $7,460.54
| Facility | | $846.23 | $1,520.52 | $7,460.54 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $207.44 / $207.44 / $207.44
| Facility | AS | $207.44 | $207.44 | $207.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,940.00 / $7,872.00 / $11,531.00
| Facility | | $3,940.00 | $7,872.00 | $11,531.00 |