- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,256.00 / $2,956.42 / $7,602.00
| Facility | | $1,256.00 | $2,956.42 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,276.00 / $6,672.00 / $11,975.00
| Facility | | $3,276.00 | $6,672.00 | $11,975.00 |
- 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
- $5,897.00 / $17,132.00 / $17,132.00
| Facility | | $5,897.00 | $17,132.00 | $17,132.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $293.06 / $1,625.25 / $1,625.25
| Facility | AS | $293.06 | $1,625.25 | $1,625.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,098.00 / $8,222.00 / $12,407.00
| Facility | | $4,098.00 | $8,222.00 | $12,407.00 |