- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $625.61 / $7,119.04 / $20,928.72
| Facility | | $625.61 | $7,119.04 | $20,928.72 |
- 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
- $5,266.26 / $5,266.26 / $5,266.26
| Facility | | $5,266.26 | $5,266.26 | $5,266.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $535.82 / $869.46 / $2,314.96
| Facility | | $535.82 | $869.46 | $2,314.96 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $223.29 / $223.29 / $223.29
| Facility | AS | $223.29 | $223.29 | $223.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,073.50 / $1,451.95 / $6,319.51
| Facility | | $1,073.50 | $1,451.95 | $6,319.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,777.00 / $8,220.00 / $9,696.00
| Facility | | $6,777.00 | $8,220.00 | $9,696.00 |