- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $3,715.35 / $8,511.38
| Facility | | $724.44 | $3,715.35 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $4,677.35 / $8,912.51
| Facility | | $2,238.72 | $4,677.35 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $2,511.89 / $2,511.89
| Facility | | $2,511.89 | $2,511.89 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $645.65 / $10,715.19
| Facility | | $398.11 | $645.65 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $107.15 / $1,584.89 / $1,584.89
| Facility | AS | $107.15 | $1,584.89 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $3,801.89 / $6,165.95
| Facility | | $2,454.71 | $3,801.89 | $6,165.95 |