- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,505.11 / $2,678.00 / $7,602.00
| Facility | | $1,505.11 | $2,678.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,852.00 / $8,397.00 / $15,167.00
| Facility | | $3,852.00 | $8,397.00 | $15,167.00 |
- 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 / $5,255.94 / $5,406.60
| Facility | | $55.00 | $5,255.94 | $5,406.60 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $191.46 / $373.55 / $373.55
| Facility | AS | $191.46 | $373.55 | $373.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,052.00 / $10,986.00 / $19,168.00
| Facility | | $5,052.00 | $10,986.00 | $19,168.00 |