- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,079.83 / $6,024.00 / $11,576.00
| Facility | | $1,079.83 | $6,024.00 | $11,576.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $400.00 / $500.00 / $3,607.44
| Facility | | $400.00 | $500.00 | $3,607.44 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $131.97 / $131.97 / $131.97
| Facility | AS | $131.97 | $131.97 | $131.97 |
- 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
- $1,788.00 / $7,558.00 / $12,040.00
| Facility | | $1,788.00 | $7,558.00 | $12,040.00 |