- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $560.16 / $2,678.00 / $7,602.00
| Facility | | $560.16 | $2,678.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $110.00 / $150.00 / $2,367.00
| Facility | | $110.00 | $150.00 | $2,367.00 |
- 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
- $3,826.76 / $4,561.06 / $5,000.00
| Facility | | $3,826.76 | $4,561.06 | $5,000.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $69.92 / $138.26 / $138.26
| Facility | AS | $69.92 | $138.26 | $138.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,233.00 / $2,665.00 / $4,918.00
| Facility | | $1,233.00 | $2,665.00 | $4,918.00 |