- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $743.02 / $8,477.27 / $21,899.37
| Facility | | $743.02 | $8,477.27 | $21,899.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,183.05 / $10,762.95 / $20,819.02
| Facility | | $8,183.05 | $10,762.95 | $20,819.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $743.02 / $1,350.96 / $4,787.75
| Facility | | $743.02 | $1,350.96 | $4,787.75 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $209.10 / $377.70 / $377.70
| Facility | AS | $209.10 | $377.70 | $377.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $941.09 / $1,842.47 / $2,524.71
| Facility | | $941.09 | $1,842.47 | $2,524.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,178.00 / $7,441.00 / $8,816.00
| Facility | | $6,178.00 | $7,441.00 | $8,816.00 |