- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $974.00 / $2,794.39 / $7,602.00
| Facility | | $974.00 | $2,794.39 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,984.00 / $5,486.00 / $9,283.00
| Facility | | $2,984.00 | $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
- $2,774.68 / $26,196.65 / $26,542.00
| Facility | | $2,774.68 | $26,196.65 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $193.65 / $2,483.07 / $2,483.07
| Facility | AS | $193.65 | $2,483.07 | $2,483.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,905.00 / $6,073.00 / $10,287.00
| Facility | | $2,905.00 | $6,073.00 | $10,287.00 |