- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,103.00 / $2,977.00 / $7,602.00
| Facility | | $1,103.00 | $2,977.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,686.00 / $5,467.00 / $9,283.00
| Facility | | $2,686.00 | $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
- $3,492.45 / $19,913.50 / $26,542.00
| Facility | | $3,492.45 | $19,913.50 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $190.73 / $1,887.52 / $1,887.52
| Facility | AS | $190.73 | $1,887.52 | $1,887.52 |
- 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 |