- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $765.70 / $4,518.60 / $13,841.56
| Facility | | $765.70 | $4,518.60 | $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
- $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
- $675.10 / $1,078.60 / $2,897.76
| Facility | | $675.10 | $1,078.60 | $2,897.76 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $284.14 / $284.14 / $284.14
| Facility | AS | $284.14 | $284.14 | $284.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,271.52 / $1,814.40 / $6,319.51
| Facility | | $1,271.52 | $1,814.40 | $6,319.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,569.59 / $8,163.00 / $9,696.00
| Facility | | $5,569.59 | $8,163.00 | $9,696.00 |