- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,352.47 / $3,435.00 / $7,602.00
| Facility | | $1,352.47 | $3,435.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,276.00 / $6,366.00 / $9,272.00
| Facility | | $3,276.00 | $6,366.00 | $9,272.00 |
- 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 / $23,532.88 / $24,033.80
| Facility | | $5,897.00 | $23,532.88 | $24,033.80 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $360.22 / $1,625.25 / $1,625.25
| Facility | AS | $360.22 | $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 |