- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,758.00 / $8,674.93 / $14,366.42
| Facility | | $1,758.00 | $8,674.93 | $14,366.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $494.00 / $7,157.00 / $30,357.00
| Facility | | $494.00 | $7,157.00 | $30,357.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $37.06 / $37.06 / $37.06
| Facility | AS | $37.06 | $37.06 | $37.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,672.00 / $12,190.00 / $22,833.00
| Facility | | $4,672.00 | $12,190.00 | $22,833.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,731.00 / $10,254.00 / $15,888.00
| Facility | | $2,731.00 | $10,254.00 | $15,888.00 |