- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $905.35 / $9,185.68 / $20,928.72
| Facility | | $905.35 | $9,185.68 | $20,928.72 |
- 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
- $13,225.82 / $13,225.82 / $13,225.82
| Facility | | $13,225.82 | $13,225.82 | $13,225.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $905.35 / $1,629.63 / $9,696.00
| Facility | | $905.35 | $1,629.63 | $9,696.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $254.28 / $4,740.35 / $4,740.35
| Facility | AS | $254.28 | $4,740.35 | $4,740.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,285.00 / $2,298.03 / $16,752.70
| Facility | | $1,285.00 | $2,298.03 | $16,752.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,777.00 / $8,220.00 / $9,696.00
| Facility | | $6,777.00 | $8,220.00 | $9,696.00 |