- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $2,818.38 / $10,471.29
| Facility | | $870.96 | $2,818.38 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,332.54 / $10,715.19 / $11,220.18
| Facility | | $9,332.54 | $10,715.19 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $1,348.96 / $1,778.28
| Facility | | $977.24 | $1,348.96 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $1,862.09 / $1,862.09
| Facility | | $34.67 | $1,862.09 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $186.21 / $186.21 / $186.21
| Facility | AS | $186.21 | $186.21 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $5,011.87 / $12,302.69
| Facility | | $977.24 | $5,011.87 | $12,302.69 |