- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $871.82 / $4,790.00 / $11,576.00
| Facility | | $871.82 | $4,790.00 | $11,576.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $400.00 / $500.00 / $3,093.44
| Facility | | $400.00 | $500.00 | $3,093.44 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $112.52 / $112.52 / $112.52
| Facility | AS | $112.52 | $112.52 | $112.52 |
- 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 |