- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,159.14 / $4,790.00 / $11,576.00
| Facility | | $1,159.14 | $4,790.00 | $11,576.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $400.00 / $500.00 / $4,114.07
| Facility | | $400.00 | $500.00 | $4,114.07 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $150.55 / $150.55 / $150.55
| Facility | AS | $150.55 | $150.55 | $150.55 |
- 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
- $573.00 / $4,414.00 / $9,150.00
| Facility | | $573.00 | $4,414.00 | $9,150.00 |