- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,103.00 / $2,678.00 / $6,681.00
| Facility | | $1,103.00 | $2,678.00 | $6,681.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,963.00 / $7,178.00 / $13,734.00
| Facility | | $2,963.00 | $7,178.00 | $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
- $4,671.05 / $26,542.00 / $50,011.20
| Facility | | $4,671.05 | $26,542.00 | $50,011.20 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $254.28 / $4,740.35 / $4,740.35
| Facility | AS | $254.28 | $4,740.35 | $4,740.35 |
- 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 |