- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,215.02 / $5,792.00 / $11,576.00
| Facility | | $1,215.02 | $5,792.00 | $11,576.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $400.00 / $500.00 / $4,330.70
| Facility | | $400.00 | $500.00 | $4,330.70 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $156.62 / $156.62 / $156.62
| Facility | AS | $156.62 | $156.62 | $156.62 |
- 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
- $1,301.00 / $5,675.00 / $9,772.00
| Facility | | $1,301.00 | $5,675.00 | $9,772.00 |