- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,821.00 / $2,766.38 / $7,602.00
| Facility | | $1,821.00 | $2,766.38 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,375.00 / $2,423.00 / $6,366.00
| Facility | | $1,375.00 | $2,423.00 | $6,366.00 |
- 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
- $55.00 / $11,421.45 / $11,672.82
| Facility | | $55.00 | $11,421.45 | $11,672.82 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $275.18 / $550.26 / $550.26
| Facility | AS | $275.18 | $550.26 | $550.26 |
- 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 |