- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $694.00 / $2,652.00 / $7,602.00
| Facility | | $694.00 | $2,652.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,132.00 / $3,728.00 / $5,878.00
| Facility | | $2,132.00 | $3,728.00 | $5,878.00 |
- 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
- $2,554.52 / $2,722.80 / $26,542.00
| Facility | | $2,554.52 | $2,722.80 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $247.81 / $272.27 / $272.27
| Facility | AS | $247.81 | $272.27 | $272.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,794.00 / $3,626.00 / $6,291.00
| Facility | | $1,794.00 | $3,626.00 | $6,291.00 |