- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,178.18 / $2,678.00 / $7,182.00
| Facility | | $1,178.18 | $2,678.00 | $7,182.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,695.00 / $5,486.00 / $9,419.00
| Facility | | $2,695.00 | $5,486.00 | $9,419.00 |
- 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
- $5,143.02 / $19,913.50 / $20,000.00
| Facility | | $5,143.02 | $19,913.50 | $20,000.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $234.10 / $1,887.52 / $1,887.52
| Facility | AS | $234.10 | $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 |