- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,690.92 / $8,477.27 / $20,928.72
| Facility | | $1,690.92 | $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
- $1,690.92 / $3,043.66 / $9,815.00
| Facility | | $1,690.92 | $3,043.66 | $9,815.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $476.09 / $919.64 / $919.64
| Facility | AS | $476.09 | $919.64 | $919.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,191.35 / $4,253.57 / $6,138.12
| Facility | | $2,191.35 | $4,253.57 | $6,138.12 |
- 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 |