- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $912.01 / $912.01
| Facility | | $912.01 | $912.01 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $870.96 / $7,413.10
| Facility | | $380.19 | $870.96 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $3,162.28 / $7,585.78
| Facility | | $2,238.72 | $3,162.28 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $154.88 / $154.88 / $154.88
| Facility | AS | $154.88 | $154.88 | $154.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $3,019.95 / $5,888.44
| Facility | | $2,454.71 | $3,019.95 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,737.80 / $3,467.37
| Facility | | $1,047.13 | $1,737.80 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $3,467.37 / $8,511.38
| Facility | | $1,584.89 | $3,467.37 | $8,511.38 |