- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $227.28 / $8,477.27 / $20,928.72
| Facility | | $227.28 | $8,477.27 | $20,928.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,766.83 / $15,476.59 / $29,936.73
| Facility | | $11,766.83 | $15,476.59 | $29,936.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $227.28 / $420.47 / $4,239.62
| Facility | | $227.28 | $420.47 | $4,239.62 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $63.29 / $120.96 / $120.96
| Facility | AS | $63.29 | $120.96 | $120.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $301.41 / $581.51 / $814.43
| Facility | | $301.41 | $581.51 | $814.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,054.00 / $4,317.00 / $13,909.00
| Facility | | $3,054.00 | $4,317.00 | $13,909.00 |