- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $984.19 / $8,042.03 / $19,276.96
| Facility | | $984.19 | $8,042.03 | $19,276.96 |
- 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
- $885.77 / $1,470.24 / $3,954.20
| Facility | | $885.77 | $1,470.24 | $3,954.20 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $387.54 / $387.54 / $387.54
| Facility | AS | $387.54 | $387.54 | $387.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,316.00 / $2,343.51 / $3,111.39
| Facility | | $1,316.00 | $2,343.51 | $3,111.39 |
- 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 |