- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,116.73 / $8,465.00 / $23,345.00
| Facility | | $1,116.73 | $8,465.00 | $23,345.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,095.64 / $7,157.00 / $39,498.00
| Facility | | $1,095.64 | $7,157.00 | $39,498.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $107.75 / $107.75 / $107.75
| Facility | AS | $107.75 | $107.75 | $107.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,133.00 / $11,764.00 / $22,518.00
| Facility | | $5,133.00 | $11,764.00 | $22,518.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,776.00 / $15,728.00 / $37,470.00
| Facility | | $5,776.00 | $15,728.00 | $37,470.00 |