- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,044.50 / $2,678.00 / $7,602.00
| Facility | | $1,044.50 | $2,678.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,367.00 / $5,434.00 / $9,419.00
| Facility | | $2,367.00 | $5,434.00 | $9,419.00 |
- 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
- $3,736.24 / $19,913.50 / $26,542.00
| Facility | | $3,736.24 | $19,913.50 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $257.26 / $1,887.52 / $1,887.52
| Facility | AS | $257.26 | $1,887.52 | $1,887.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,604.00 / $5,898.00 / $11,506.00
| Facility | | $3,604.00 | $5,898.00 | $11,506.00 |