- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $1,778.28 / $8,511.38
| Facility | | $794.33 | $1,778.28 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,128.31 / $10,715.19 / $12,882.50
| Facility | | $8,128.31 | $10,715.19 | $12,882.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $1,148.15 / $1,348.96
| Facility | | $812.83 | $1,148.15 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $1,548.82 / $1,548.82
| Facility | | $34.67 | $1,548.82 | $1,548.82 |
- 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
- $602.56 / $4,466.84 / $30,199.52
| Facility | | $602.56 | $4,466.84 | $30,199.52 |