- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,190.02 / $2,977.00 / $7,602.00
| Facility | | $1,190.02 | $2,977.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,897.00 / $7,138.00 / $13,961.00
| Facility | | $2,897.00 | $7,138.00 | $13,961.00 |
- 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
- $3,520.60 / $26,542.00 / $55,007.05
| Facility | | $3,520.60 | $26,542.00 | $55,007.05 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $242.52 / $5,213.89 / $5,213.89
| Facility | AS | $242.52 | $5,213.89 | $5,213.89 |
- 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 |