- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $3,890.45 / $9,772.37
| Facility | | $933.25 | $3,890.45 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,888.44 / $9,332.54 / $14,791.08
| Facility | | $5,888.44 | $9,332.54 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,623.41 / $5,623.41 / $5,623.41
| Facility | | $5,623.41 | $5,623.41 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $1,995.26 / $10,232.93
| Facility | | $691.83 | $1,995.26 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $169.82 / $1,905.46 / $1,905.46
| Facility | AS | $169.82 | $1,905.46 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $5,754.40 / $10,715.19
| Facility | | $1,621.81 | $5,754.40 | $10,715.19 |