- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.00 / $3,939.75 / $7,602.00
| Facility | | $1,122.00 | $3,939.75 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,816.00 / $9,102.00 / $16,372.00
| Facility | | $2,816.00 | $9,102.00 | $16,372.00 |
- 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
- $7,186.95 / $102,689.75 / $102,689.75
| Facility | | $7,186.95 | $102,689.75 | $102,689.75 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $207.89 / $9,733.53 / $9,733.53
| Facility | AS | $207.89 | $9,733.53 | $9,733.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,052.00 / $10,398.00 / $33,296.00
| Facility | | $5,052.00 | $10,398.00 | $33,296.00 |