- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $714.22 / $2,678.00 / $7,602.00
| Facility | | $714.22 | $2,678.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,430.00 / $5,486.00 / $9,419.00
| Facility | | $2,430.00 | $5,486.00 | $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
- $3,238.68 / $25,906.30 / $26,542.00
| Facility | | $3,238.68 | $25,906.30 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $148.13 / $2,455.55 / $2,455.55
| Facility | AS | $148.13 | $2,455.55 | $2,455.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,964.00 / $8,273.00 / $12,407.00
| Facility | | $3,964.00 | $8,273.00 | $12,407.00 |