- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $933.25 / $6,760.83
| Facility | | $933.25 | $933.25 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,623.41 / $24,547.09 / $58,884.37
| Facility | | $5,623.41 | $24,547.09 | $58,884.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $3,388.44 / $8,128.31
| Facility | | $2,398.83 | $3,388.44 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $158.49 / $158.49 / $158.49
| Facility | AS | $158.49 | $158.49 | $158.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $3,311.31 / $6,456.54
| Facility | | $2,630.27 | $3,311.31 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $1,819.70 / $10,715.19
| Facility | | $977.24 | $1,819.70 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $9,120.11 / $13,182.57
| Facility | | $4,365.16 | $9,120.11 | $13,182.57 |