- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $781.00 / $2,311.00 / $7,602.00
| Facility | | $781.00 | $2,311.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,056.00 / $5,467.00 / $9,283.00
| Facility | | $2,056.00 | $5,467.00 | $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 / $5,201.77 / $5,303.62
| Facility | | $55.00 | $5,201.77 | $5,303.62 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $165.34 / $327.73 / $327.73
| Facility | AS | $165.34 | $327.73 | $327.73 |
- 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 |