- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,353.00 / $8,477.27 / $20,928.72
| Facility | | $1,353.00 | $8,477.27 | $20,928.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,766.83 / $15,476.59 / $29,936.73
| Facility | | $11,766.83 | $15,476.59 | $29,936.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,353.00 / $2,435.40 / $9,815.00
| Facility | | $1,353.00 | $2,435.40 | $9,815.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $380.34 / $723.76 / $723.76
| Facility | AS | $380.34 | $723.76 | $723.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,745.19 / $3,394.08 / $4,836.68
| Facility | | $1,745.19 | $3,394.08 | $4,836.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,148.00 / $9,696.00 / $15,622.00
| Facility | | $8,148.00 | $9,696.00 | $15,622.00 |