- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,529.63 / $8,477.27 / $20,928.72
| Facility | | $1,529.63 | $8,477.27 | $20,928.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,828.40 / $10,296.48 / $19,916.72
| Facility | | $7,828.40 | $10,296.48 | $19,916.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,529.63 / $2,753.33 / $9,496.00
| Facility | | $1,529.63 | $2,753.33 | $9,496.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $429.59 / $812.47 / $812.47
| Facility | AS | $429.59 | $812.47 | $812.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,988.53 / $3,862.28 / $5,440.47
| Facility | | $1,988.53 | $3,862.28 | $5,440.47 |
- 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 |