- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $959.20 / $3,692.00 / $6,681.00
| Facility | | $959.20 | $3,692.00 | $6,681.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,367.00 / $5,486.00 / $9,283.00
| Facility | | $2,367.00 | $5,486.00 | $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
- $2,000.00 / $19,913.50 / $19,913.50
| Facility | | $2,000.00 | $19,913.50 | $19,913.50 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $193.64 / $1,887.52 / $1,887.52
| Facility | AS | $193.64 | $1,887.52 | $1,887.52 |
- 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 |