- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $362.58 / $2,765.26 / $8,130.00
| Facility | | $362.58 | $2,765.26 | $8,130.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,143.00 / $4,974.00 / $11,797.00
| Facility | | $2,143.00 | $4,974.00 | $11,797.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,571.00 / $25,867.00 / $33,037.00
| Facility | | $21,571.00 | $25,867.00 | $33,037.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $16.93 / $16.93 / $16.93
| Facility | AS | $16.93 | $16.93 | $16.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $376.00 / $1,221.00 / $2,883.00
| Facility | | $376.00 | $1,221.00 | $2,883.00 |