- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $3,311.31 / $8,709.64
| Facility | | $794.33 | $3,311.31 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $4,466.84 / $12,022.64
| Facility | | $2,818.38 | $4,466.84 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $776.25 / $912.01
| Facility | | $549.54 | $776.25 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,047.13 / $3,019.95
| Facility | | $1,047.13 | $1,047.13 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $104.71 / $104.71 / $104.71
| Facility | AS | $104.71 | $104.71 | $104.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $3,890.45 / $8,511.38
| Facility | | $741.31 | $3,890.45 | $8,511.38 |