- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $825.44 / $8,960.00 / $16,467.00
| Facility | | $825.44 | $8,960.00 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,043.58 / $10,374.89 / $18,314.23
| Facility | | $5,043.58 | $10,374.89 | $18,314.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $820.52 / $1,077.00 / $1,573.96
| Facility | | $820.52 | $1,077.00 | $1,573.96 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $127.54 / $182.44 / $215.83
| Facility | AS | $127.54 | $182.44 | $215.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,912.00 / $16,223.00 / $23,485.00
| Facility | | $2,912.00 | $16,223.00 | $23,485.00 |