- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,586.56 / $2,977.00 / $6,681.00
| Facility | | $1,586.56 | $2,977.00 | $6,681.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,895.00 / $7,138.00 / $13,623.00
| Facility | | $2,895.00 | $7,138.00 | $13,623.00 |
- 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
- $4,934.20 / $26,542.00 / $50,972.05
| Facility | | $4,934.20 | $26,542.00 | $50,972.05 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $337.62 / $4,831.43 / $4,831.43
| Facility | AS | $337.62 | $4,831.43 | $4,831.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,098.00 / $8,273.00 / $12,407.00
| Facility | | $4,098.00 | $8,273.00 | $12,407.00 |