- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $2,678.00 / $7,602.00
| Facility | | $900.00 | $2,678.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,367.00 / $5,486.00 / $9,272.00
| Facility | | $2,367.00 | $5,486.00 | $9,272.00 |
- 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
- $3,205.20 / $26,542.00 / $27,234.40
| Facility | | $3,205.20 | $26,542.00 | $27,234.40 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $175.82 / $2,581.44 / $2,581.44
| Facility | AS | $175.82 | $2,581.44 | $2,581.44 |
- 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 |