- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,661.39 / $3,613.77 / $7,602.00
| Facility | | $1,661.39 | $3,613.77 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,984.00 / $5,616.00 / $9,283.00
| Facility | | $2,984.00 | $5,616.00 | $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
- $55.00 / $27,742.39 / $28,326.61
| Facility | | $55.00 | $27,742.39 | $28,326.61 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $472.53 / $925.85 / $925.85
| Facility | AS | $472.53 | $925.85 | $925.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,799.00 / $5,709.00 / $10,111.00
| Facility | | $2,799.00 | $5,709.00 | $10,111.00 |