- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.00 / $2,678.00 / $7,602.00
| Facility | | $1,230.00 | $2,678.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,367.00 / $5,467.00 / $9,272.00
| Facility | | $2,367.00 | $5,467.00 | $9,272.00 |
- 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
- $3,905.52 / $19,913.50 / $26,542.00
| Facility | | $3,905.52 | $19,913.50 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $268.62 / $1,887.52 / $1,887.52
| Facility | AS | $268.62 | $1,887.52 | $1,887.52 |
- 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 |