- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,058.50 / $2,678.00 / $7,602.00
| Facility | | $1,058.50 | $2,678.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,430.00 / $5,434.00 / $9,283.00
| Facility | | $2,430.00 | $5,434.00 | $9,283.00 |
- 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
- $5,481.72 / $26,542.00 / $26,827.20
| Facility | | $5,481.72 | $26,542.00 | $26,827.20 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $249.23 / $2,542.84 / $2,542.84
| Facility | AS | $249.23 | $2,542.84 | $2,542.84 |
- 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 |