- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $663.75 / $8,042.03 / $19,276.96
| Facility | | $663.75 | $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
- $589.24 / $936.62 / $2,554.52
| Facility | | $589.24 | $936.62 | $2,554.52 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $247.81 / $247.81 / $247.81
| Facility | AS | $247.81 | $247.81 | $247.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,089.00 / $1,579.32 / $2,842.49
| Facility | | $1,089.00 | $1,579.32 | $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 |