- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $725.83 / $9,185.68 / $20,928.72
| Facility | | $725.83 | $9,185.68 | $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
- $7,173.26 / $7,173.26 / $7,173.26
| Facility | | $7,173.26 | $7,173.26 | $7,173.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $632.58 / $1,014.03 / $2,732.72
| Facility | | $632.58 | $1,014.03 | $2,732.72 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $266.74 / $266.74 / $266.74
| Facility | AS | $266.74 | $266.74 | $266.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,282.39 / $1,718.33 / $8,607.91
| Facility | | $1,282.39 | $1,718.33 | $8,607.91 |
- 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 |