- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $553.94 / $2,678.00 / $7,602.00
| Facility | | $553.94 | $2,678.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,430.00 / $5,486.00 / $9,283.00
| Facility | | $2,430.00 | $5,486.00 | $9,283.00 |
- 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
- $2,370.32 / $25,114.25 / $26,542.00
| Facility | | $2,370.32 | $25,114.25 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $162.91 / $2,380.48 / $2,380.48
| Facility | AS | $162.91 | $2,380.48 | $2,380.48 |
- 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 |