- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $565.75 / $4,778.89 / $13,841.56
| Facility | | $565.75 | $4,778.89 | $13,841.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,362.84 / $10,999.42 / $21,276.43
| Facility | | $8,362.84 | $10,999.42 | $21,276.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,368.73 / $2,368.73 / $2,368.73
| Facility | | $2,368.73 | $2,368.73 | $2,368.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $460.81 / $734.56 / $1,978.80
| Facility | | $460.81 | $734.56 | $1,978.80 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $194.23 / $194.23 / $194.23
| Facility | AS | $194.23 | $194.23 | $194.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.77 / $1,342.78 / $2,842.49
| Facility | | $933.77 | $1,342.78 | $2,842.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,217.00 / $6,451.00 / $7,934.00
| Facility | | $4,217.00 | $6,451.00 | $7,934.00 |