- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,003.00 / $3,863.00 / $11,235.77
| Facility | | $1,003.00 | $3,863.00 | $11,235.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,146.00 / $7,133.00 / $13,149.00
| Facility | | $3,146.00 | $7,133.00 | $13,149.00 |
- 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
- $3,214.25 / $26,542.00 / $54,442.25
| Facility | | $3,214.25 | $26,542.00 | $54,442.25 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $176.13 / $5,160.35 / $5,160.35
| Facility | AS | $176.13 | $5,160.35 | $5,160.35 |
- 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 |