- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,656.00 / $3,939.75 / $7,602.00
| Facility | | $1,656.00 | $3,939.75 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,367.00 / $7,133.00 / $13,734.00
| Facility | | $2,367.00 | $7,133.00 | $13,734.00 |
- 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
- $2,000.00 / $18,864.66 / $19,297.63
| Facility | | $2,000.00 | $18,864.66 | $19,297.63 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $369.77 / $742.52 / $742.52
| Facility | AS | $369.77 | $742.52 | $742.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,964.00 / $8,273.00 / $12,407.00
| Facility | | $3,964.00 | $8,273.00 | $12,407.00 |