- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $1,513.56 / $6,606.93
| Facility | | $707.95 | $1,513.56 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,413.10 / $11,748.98 / $18,620.87
| Facility | | $7,413.10 | $11,748.98 | $18,620.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,762.47 / $7,762.47 / $7,762.47
| Facility | | $7,762.47 | $7,762.47 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $1,949.84 / $14,125.38
| Facility | | $691.83 | $1,949.84 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $181.97 / $2,570.40 / $2,570.40
| Facility | AS | $181.97 | $2,570.40 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $7,762.47 / $14,454.40
| Facility | | $1,949.84 | $7,762.47 | $14,454.40 |