- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $2,884.03 / $4,365.16
| Facility | | $933.25 | $2,884.03 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $8,511.38 / $12,022.64
| Facility | | $5,011.87 | $8,511.38 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $1,778.28 / $1,778.28
| Facility | | $39.81 | $1,778.28 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $812.83 / $3,388.44
| Facility | | $489.78 | $812.83 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $338.84 / $338.84 / $338.84
| Facility | AS | $338.84 | $338.84 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $1,174.90 / $5,754.40
| Facility | | $371.54 | $1,174.90 | $5,754.40 |