- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $4,265.80 / $11,481.54
| Facility | | $776.25 | $4,265.80 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $6,025.60 / $16,218.10
| Facility | | $2,511.89 | $6,025.60 | $16,218.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,456.54 / $9,772.37 / $14,791.08
| Facility | | $6,456.54 | $9,772.37 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $1,148.15 / $12,882.50
| Facility | | $616.60 | $1,148.15 | $12,882.50 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $173.78 / $851.14 / $851.14
| Facility | AS | $173.78 | $851.14 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $3,467.37 / $10,232.93
| Facility | | $2,454.71 | $3,467.37 | $10,232.93 |