- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $8,331.02 / $11,024.00
| Facility | | $1,000.00 | $8,331.02 | $11,024.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $440.76 / $440.76 / $6,644.00
| Facility | | $440.76 | $440.76 | $6,644.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $43.36 / $43.36 / $43.36
| Facility | AS | $43.36 | $43.36 | $43.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,730.36 / $6,821.00 / $22,063.00
| Facility | | $1,730.36 | $6,821.00 | $22,063.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,392.00 / $10,236.00 / $17,744.00
| Facility | | $2,392.00 | $10,236.00 | $17,744.00 |