- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $7,244.36 / $15,848.93
| Facility | | $831.76 | $7,244.36 | $15,848.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $11,481.54 / $22,387.21
| Facility | | $5,370.32 | $11,481.54 | $22,387.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $3,311.31 / $7,943.28
| Facility | | $2,344.23 | $3,311.31 | $7,943.28 |
- 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
- $2,570.40 / $3,162.28 / $6,165.95
| Facility | | $2,570.40 | $3,162.28 | $6,165.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $3,162.28 / $12,589.25
| Facility | | $1,230.27 | $3,162.28 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $6,456.54 / $12,589.25
| Facility | | $3,311.31 | $6,456.54 | $12,589.25 |