- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,295.20 / $3,085.00 / $7,602.00
| Facility | | $1,295.20 | $3,085.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,897.00 / $7,097.00 / $13,498.00
| Facility | | $2,897.00 | $7,097.00 | $13,498.00 |
- 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
- $3,760.76 / $26,542.00 / $54,390.30
| Facility | | $3,760.76 | $26,542.00 | $54,390.30 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $258.20 / $5,155.43 / $5,155.43
| Facility | AS | $258.20 | $5,155.43 | $5,155.43 |
- 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 |