- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,821.00 / $4,069.00 / $10,746.00
| Facility | | $1,821.00 | $4,069.00 | $10,746.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,582.00 / $9,558.00 / $16,372.00
| Facility | | $4,582.00 | $9,558.00 | $16,372.00 |
- 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
- $10,811.68 / $26,542.00 / $81,089.45
| Facility | | $10,811.68 | $26,542.00 | $81,089.45 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $367.74 / $7,686.13 / $7,686.13
| Facility | AS | $367.74 | $7,686.13 | $7,686.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,052.00 / $10,848.00 / $19,168.00
| Facility | | $5,052.00 | $10,848.00 | $19,168.00 |