- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,225.58 / $5,729.11 / $24,724.00
| Facility | | $2,225.58 | $5,729.11 | $24,724.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,157.00 / $7,266.00 / $13,734.00
| Facility | | $3,157.00 | $7,266.00 | $13,734.00 |
- 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
- $5,362.25 / $51,514.20 / $51,514.20
| Facility | | $5,362.25 | $51,514.20 | $51,514.20 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $291.30 / $4,882.81 / $4,882.81
| Facility | AS | $291.30 | $4,882.81 | $4,882.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,052.00 / $12,700.00 / $29,870.00
| Facility | | $5,052.00 | $12,700.00 | $29,870.00 |