- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,124.32 / $2,794.39 / $6,681.00
| Facility | | $1,124.32 | $2,794.39 | $6,681.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,830.00 / $5,500.00 / $9,419.00
| Facility | | $2,830.00 | $5,500.00 | $9,419.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.00 / $30.00 / $30.00
| Facility | | $30.00 | $30.00 | $30.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,206.24 / $25,530.00 / $26,542.00
| Facility | | $7,206.24 | $25,530.00 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $327.41 / $2,419.88 / $2,419.88
| Facility | AS | $327.41 | $2,419.88 | $2,419.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,905.00 / $6,073.00 / $10,287.00
| Facility | | $2,905.00 | $6,073.00 | $10,287.00 |