- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,615.00 / $1,910.59 / $7,439.00
| Facility | | $1,615.00 | $1,910.59 | $7,439.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.10 / $606.10 / $606.10
| Facility | | $606.10 | $606.10 | $606.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,910.59 / $2,437.30 / $3,996.00
| Facility | | $1,910.59 | $2,437.30 | $3,996.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $313.74 / $341.22 / $604.51
| Facility | AS | $313.74 | $341.22 | $604.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,028.00 / $3,828.00 / $6,388.00
| Facility | | $1,028.00 | $3,828.00 | $6,388.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,000.00 / $19,768.86 / $19,768.86
| Facility | | $5,000.00 | $19,768.86 | $19,768.86 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $270.00 / $479.24 / $944.09
| Facility | AS | $270.00 | $479.24 | $944.09 |