- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $1,778.28 / $8,511.38
| Facility | | $707.95 | $1,778.28 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,549.93 / $11,220.18 / $11,748.98
| Facility | | $9,549.93 | $11,220.18 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $1,122.02 / $1,548.82
| Facility | | $776.25 | $1,122.02 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $1,513.56 / $1,513.56
| Facility | | $34.67 | $1,513.56 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $151.36 / $151.36 / $151.36
| Facility | AS | $151.36 | $151.36 | $151.36 |
- 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 |