- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,464.45 / $4,069.00 / $24,724.00
| Facility | | $1,464.45 | $4,069.00 | $24,724.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,367.00 / $7,097.00 / $13,623.00
| Facility | | $2,367.00 | $7,097.00 | $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
- $55.00 / $17,119.08 / $17,475.84
| Facility | | $55.00 | $17,119.08 | $17,475.84 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $421.43 / $826.78 / $826.78
| Facility | AS | $421.43 | $826.78 | $826.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,052.00 / $13,014.00 / $29,870.00
| Facility | | $5,052.00 | $13,014.00 | $29,870.00 |