- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,486.14 / $6,024.00 / $12,514.00
| Facility | | $1,486.14 | $6,024.00 | $12,514.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $400.00 / $510.00 / $6,763.00
| Facility | | $400.00 | $510.00 | $6,763.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $196.33 / $196.33 / $196.33
| Facility | AS | $196.33 | $196.33 | $196.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,600.00 / $19,859.00 / $31,911.00
| Facility | | $6,600.00 | $19,859.00 | $31,911.00 |
- 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 |