- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $977.24 / $2,630.27
| Facility | | $977.24 | $977.24 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $14,454.40 / $29,512.09
| Facility | | $6,165.95 | $14,454.40 | $29,512.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $3,548.13 / $8,511.38
| Facility | | $2,511.89 | $3,548.13 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $169.82 / $169.82 / $169.82
| Facility | AS | $169.82 | $169.82 | $169.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $3,388.44 / $6,760.83
| Facility | | $2,754.23 | $3,388.44 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $1,905.46 / $9,772.37
| Facility | | $954.99 | $1,905.46 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $6,309.57 / $12,589.25
| Facility | | $3,235.94 | $6,309.57 | $12,589.25 |