- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $956.39 / $8,477.27 / $20,928.72
| Facility | | $956.39 | $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
- $956.39 / $1,673.68 / $4,406.00
| Facility | | $956.39 | $1,673.68 | $4,406.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $269.73 / $502.44 / $502.44
| Facility | AS | $269.73 | $502.44 | $502.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,229.78 / $2,402.53 / $3,363.13
| Facility | | $1,229.78 | $2,402.53 | $3,363.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,054.00 / $4,317.00 / $13,909.00
| Facility | | $3,054.00 | $4,317.00 | $13,909.00 |