- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,615.00 / $2,257.40 / $7,439.00
| Facility | | $1,615.00 | $2,257.40 | $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
- $2,257.40 / $3,021.69 / $4,251.55
| Facility | | $2,257.40 | $3,021.69 | $4,251.55 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $394.13 / $508.48 / $714.24
| Facility | AS | $394.13 | $508.48 | $714.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $806.00 / $3,994.00 / $6,543.00
| Facility | | $806.00 | $3,994.00 | $6,543.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,000.00 / $28,774.13 / $28,774.13
| Facility | | $5,000.00 | $28,774.13 | $28,774.13 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $321.14 / $562.04 / $1,124.02
| Facility | AS | $321.14 | $562.04 | $1,124.02 |