- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $952.20 / $8,355.33 / $19,276.96
| Facility | | $952.20 | $8,355.33 | $19,276.96 |
- 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
- $5,266.26 / $5,266.26 / $5,266.26
| Facility | | $5,266.26 | $5,266.26 | $5,266.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $952.20 / $1,666.35 / $9,496.00
| Facility | | $952.20 | $1,666.35 | $9,496.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $268.62 / $1,887.52 / $1,887.52
| Facility | AS | $268.62 | $1,887.52 | $1,887.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,242.99 / $2,542.01 / $7,991.51
| Facility | | $1,242.99 | $2,542.01 | $7,991.51 |
- 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 |