- 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
- $2,662.00 / $7,266.00 / $13,734.00
| Facility | | $2,662.00 | $7,266.00 | $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 / $19,253.63 / $19,683.73
| Facility | | $2,000.00 | $19,253.63 | $19,683.73 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $378.42 / $760.25 / $760.25
| Facility | AS | $378.42 | $760.25 | $760.25 |
- 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 |