- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,103.00 / $2,683.00 / $7,602.00
| Facility | | $1,103.00 | $2,683.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,895.00 / $7,133.00 / $13,734.00
| Facility | | $2,895.00 | $7,133.00 | $13,734.00 |
- 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
- $6,080.10 / $26,542.00 / $51,056.45
| Facility | | $6,080.10 | $26,542.00 | $51,056.45 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $276.79 / $4,839.43 / $4,839.43
| Facility | AS | $276.79 | $4,839.43 | $4,839.43 |
- 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 |