- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $4,897.79 / $14,125.38
| Facility | | $977.24 | $4,897.79 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,456.54 / $14,454.40 / $19,498.45
| Facility | | $6,456.54 | $14,454.40 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $912.01 / $1,023.29
| Facility | | $870.96 | $912.01 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $1,584.89 / $1,584.89
| Facility | | $758.58 | $1,584.89 | $1,584.89 |
- 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
- $3,235.94 / $8,317.64 / $11,220.18
| Facility | | $3,235.94 | $8,317.64 | $11,220.18 |