- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,458.16 / $3,478.00 / $7,602.00
| Facility | | $1,458.16 | $3,478.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,276.00 / $6,794.00 / $11,975.00
| Facility | | $3,276.00 | $6,794.00 | $11,975.00 |
- 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 / $20,179.93 / $20,662.07
| Facility | | $5,000.00 | $20,179.93 | $20,662.07 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $393.31 / $1,887.52 / $1,887.52
| Facility | AS | $393.31 | $1,887.52 | $1,887.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,964.00 / $8,222.00 / $12,407.00
| Facility | | $3,964.00 | $8,222.00 | $12,407.00 |