- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,256.00 / $3,243.58 / $7,602.00
| Facility | | $1,256.00 | $3,243.58 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,013.00 / $6,491.00 / $9,419.00
| Facility | | $3,013.00 | $6,491.00 | $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
- $55.00 / $9,832.62 / $10,033.52
| Facility | | $55.00 | $9,832.62 | $10,033.52 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $311.73 / $613.33 / $613.33
| Facility | AS | $311.73 | $613.33 | $613.33 |
- 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 |