- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $639.57 / $3,939.75 / $7,403.00
| Facility | | $639.57 | $3,939.75 | $7,403.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,017.00 / $8,156.00 / $13,734.00
| Facility | | $4,017.00 | $8,156.00 | $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
- $5,000.00 / $11,808.72 / $12,033.84
| Facility | | $5,000.00 | $11,808.72 | $12,033.84 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $184.06 / $368.52 / $368.52
| Facility | AS | $184.06 | $368.52 | $368.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,250.00 / $7,746.00 / $12,782.00
| Facility | | $4,250.00 | $7,746.00 | $12,782.00 |