- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $2,818.38 / $8,511.38
| Facility | | $758.58 | $2,818.38 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,244.36 / $10,715.19 / $11,220.18
| Facility | | $7,244.36 | $10,715.19 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $977.24 / $1,258.93
| Facility | | $741.31 | $977.24 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $1,318.26 / $1,318.26
| Facility | | $34.67 | $1,318.26 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $131.83 / $131.83 / $131.83
| Facility | AS | $131.83 | $131.83 | $131.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $6,760.83 / $15,488.17
| Facility | | $1,174.90 | $6,760.83 | $15,488.17 |