- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.00 / $3,939.75 / $7,602.00
| Facility | | $1,122.00 | $3,939.75 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,330.00 / $7,133.00 / $13,734.00
| Facility | | $2,330.00 | $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
- $5,000.00 / $11,371.08 / $11,605.72
| Facility | | $5,000.00 | $11,371.08 | $11,605.72 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $177.44 / $355.29 / $355.29
| Facility | AS | $177.44 | $355.29 | $355.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,098.00 / $8,273.00 / $12,407.00
| Facility | | $4,098.00 | $8,273.00 | $12,407.00 |