- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $570.96 / $3,748.00 / $8,229.00
| Facility | | $570.96 | $3,748.00 | $8,229.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,432.00 / $7,578.00 / $15,328.00
| Facility | | $4,432.00 | $7,578.00 | $15,328.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $550.00 / $550.00 / $1,173.66
| Facility | | $550.00 | $550.00 | $1,173.66 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $28.15 / $28.15 / $28.15
| Facility | AS | $28.15 | $28.15 | $28.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,793.00 / $7,693.00 / $14,770.00
| Facility | | $3,793.00 | $7,693.00 | $14,770.00 |