- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,040.04 / $3,940.00 / $10,234.00
| Facility | | $1,040.04 | $3,940.00 | $10,234.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,367.00 / $5,467.00 / $9,283.00
| Facility | | $2,367.00 | $5,467.00 | $9,283.00 |
- 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
- $3,025.38 / $19,913.50 / $26,542.00
| Facility | | $3,025.38 | $19,913.50 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $138.38 / $1,887.52 / $1,887.52
| Facility | AS | $138.38 | $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 |