- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $916.56 / $5,618.00 / $11,576.00
| Facility | | $916.56 | $5,618.00 | $11,576.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $400.00 / $500.00 / $3,059.87
| Facility | | $400.00 | $500.00 | $3,059.87 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $111.55 / $111.55 / $111.55
| Facility | AS | $111.55 | $111.55 | $111.55 |
- 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 |