- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $2,630.27 / $6,760.83
| Facility | | $812.83 | $2,630.27 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,025.60 / $9,332.54 / $15,488.17
| Facility | | $6,025.60 | $9,332.54 | $15,488.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,413.10 / $7,413.10 / $7,413.10
| Facility | | $7,413.10 | $7,413.10 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $2,187.76 / $14,125.38
| Facility | | $676.08 | $2,187.76 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $169.82 / $2,454.71 / $2,454.71
| Facility | AS | $169.82 | $2,454.71 | $2,454.71 |
- 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 |