- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,027.85 / $5,839.00 / $11,576.00
| Facility | | $1,027.85 | $5,839.00 | $11,576.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $400.00 / $500.00 / $3,555.57
| Facility | | $400.00 | $500.00 | $3,555.57 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $128.13 / $128.13 / $128.13
| Facility | AS | $128.13 | $128.13 | $128.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,460.00 / $21,065.00 / $32,051.00
| Facility | | $9,460.00 | $21,065.00 | $32,051.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $615.00 / $4,414.00 / $11,244.00
| Facility | | $615.00 | $4,414.00 | $11,244.00 |