- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $2,818.38 / $18,620.87
| Facility | | $912.01 | $2,818.38 | $18,620.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $10,964.78 / $40,738.03
| Facility | | $2,344.23 | $10,964.78 | $40,738.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $12,302.69 / $21,877.62
| Facility | | $1,071.52 | $12,302.69 | $21,877.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $912.01 / $4,786.30
| Facility | | $398.11 | $912.01 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $204.17 / $204.17 / $204.17
| Facility | AS | $204.17 | $204.17 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $4,897.79 / $11,481.54
| Facility | | $2,884.03 | $4,897.79 | $11,481.54 |