- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,173.18 / $6,024.00 / $11,624.00
| Facility | | $1,173.18 | $6,024.00 | $11,624.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $400.00 / $500.00 / $4,163.83
| Facility | | $400.00 | $500.00 | $4,163.83 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $152.11 / $152.11 / $152.11
| Facility | AS | $152.11 | $152.11 | $152.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,624.00 / $21,162.00 / $32,051.00
| Facility | | $9,624.00 | $21,162.00 | $32,051.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,788.00 / $7,558.00 / $12,040.00
| Facility | | $1,788.00 | $7,558.00 | $12,040.00 |