- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,061.00 / $2,311.00 / $7,602.00
| Facility | | $1,061.00 | $2,311.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,052.00 / $5,467.00 / $9,283.00
| Facility | | $2,052.00 | $5,467.00 | $9,283.00 |
- 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
- $4,630.85 / $16,394.00 / $17,524.30
| Facility | | $4,630.85 | $16,394.00 | $17,524.30 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $251.53 / $1,661.06 / $1,661.06
| Facility | AS | $251.53 | $1,661.06 | $1,661.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,604.00 / $5,898.00 / $11,506.00
| Facility | | $3,604.00 | $5,898.00 | $11,506.00 |