- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $917.23 / $2,725.99 / $6,888.57
| Facility | | $917.23 | $2,725.99 | $6,888.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,430.00 / $5,467.00 / $9,283.00
| Facility | | $2,430.00 | $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
- $4,031.82 / $25,188.10 / $26,542.00
| Facility | | $4,031.82 | $25,188.10 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $186.66 / $2,387.48 / $2,387.48
| Facility | AS | $186.66 | $2,387.48 | $2,387.48 |
- 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 |