- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,150.00 / $3,320.98 / $7,602.00
| Facility | | $1,150.00 | $3,320.98 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,830.00 / $5,467.00 / $9,283.00
| Facility | | $2,830.00 | $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
- $55.00 / $7,151.60 / $7,306.25
| Facility | | $55.00 | $7,151.60 | $7,306.25 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $317.08 / $621.90 / $621.90
| Facility | AS | $317.08 | $621.90 | $621.90 |
- 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 |