- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,517.00 / $3,940.00 / $16,861.71
| Facility | | $1,517.00 | $3,940.00 | $16,861.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,052.00 / $9,265.00 / $16,534.00
| Facility | | $3,052.00 | $9,265.00 | $16,534.00 |
- 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
- $6,916.20 / $26,542.00 / $80,518.70
| Facility | | $6,916.20 | $26,542.00 | $80,518.70 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $313.63 / $7,632.03 / $7,632.03
| Facility | AS | $313.63 | $7,632.03 | $7,632.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,098.00 / $8,273.00 / $12,407.00
| Facility | | $4,098.00 | $8,273.00 | $12,407.00 |