- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $984.81 / $7,214.25 / $7,444.22
| Facility | | $984.81 | $7,214.25 | $7,444.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,697.66 / $22,439.74 / $46,771.99
| Facility | | $4,697.66 | $22,439.74 | $46,771.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,389.96 / $3,391.00 / $8,157.51
| Facility | | $2,389.96 | $3,391.00 | $8,157.51 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $112.33 / $112.33 / $112.33
| Facility | AS | $112.33 | $112.33 | $112.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,172.69 / $3,100.19 / $6,423.24
| Facility | | $2,172.69 | $3,100.19 | $6,423.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,031.49 / $1,715.73 / $8,506.49
| Facility | | $1,031.49 | $1,715.73 | $8,506.49 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $254.28 / $254.28 / $254.28
| Facility | AS | $254.28 | $254.28 | $254.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,577.00 / $10,743.00 / $13,109.00
| Facility | | $5,577.00 | $10,743.00 | $13,109.00 |