- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,398.58 / $2,876.43 / $19,797.07
| Facility | | $1,398.58 | $2,876.43 | $19,797.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,897.00 / $7,133.00 / $13,623.00
| Facility | | $2,897.00 | $7,133.00 | $13,623.00 |
- 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
- $5,068.89 / $26,542.00 / $50,942.85
| Facility | | $5,068.89 | $26,542.00 | $50,942.85 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $276.58 / $4,828.66 / $4,828.66
| Facility | AS | $276.58 | $4,828.66 | $4,828.66 |
- 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 |