- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $902.77 / $3,048.50 / $9,149.87
| Facility | | $902.77 | $3,048.50 | $9,149.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,430.00 / $5,467.00 / $9,419.00
| Facility | | $2,430.00 | $5,467.00 | $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
- $3,332.55 / $26,542.00 / $27,093.50
| Facility | | $3,332.55 | $26,542.00 | $27,093.50 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $182.62 / $2,568.08 / $2,568.08
| Facility | AS | $182.62 | $2,568.08 | $2,568.08 |
- 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 |