- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,474.37 / $2,977.00 / $7,602.00
| Facility | | $1,474.37 | $2,977.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,897.00 / $7,097.00 / $13,149.00
| Facility | | $2,897.00 | $7,097.00 | $13,149.00 |
- 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
- $2,910.40 / $26,542.00 / $53,585.20
| Facility | | $2,910.40 | $26,542.00 | $53,585.20 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $201.22 / $5,079.12 / $5,079.12
| Facility | AS | $201.22 | $5,079.12 | $5,079.12 |
- 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 |