- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,492.72 / $3,478.00 / $7,602.00
| Facility | | $1,492.72 | $3,478.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,276.00 / $6,366.00 / $9,419.00
| Facility | | $3,276.00 | $6,366.00 | $9,419.00 |
- 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 / $20,700.13 / $21,257.83
| Facility | | $5,000.00 | $20,700.13 | $21,257.83 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $402.97 / $809.38 / $809.38
| Facility | AS | $402.97 | $809.38 | $809.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,964.00 / $8,273.00 / $12,407.00
| Facility | | $3,964.00 | $8,273.00 | $12,407.00 |