- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $758.58 / $2,630.27
| Facility | | $758.58 | $758.58 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $4,897.79 / $13,803.84
| Facility | | $3,090.30 | $4,897.79 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $2,884.03 / $6,760.83
| Facility | | $1,995.26 | $2,884.03 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $134.90 / $134.90 / $134.90
| Facility | AS | $134.90 | $134.90 | $134.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $2,754.23 / $5,370.32
| Facility | | $2,187.76 | $2,754.23 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $1,513.56 / $5,011.87
| Facility | | $812.83 | $1,513.56 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $4,786.30 / $8,912.51
| Facility | | $2,398.83 | $4,786.30 | $8,912.51 |