- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,541.11 / $3,478.00 / $7,602.00
| Facility | | $1,541.11 | $3,478.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,387.00 / $6,391.00 / $9,272.00
| Facility | | $3,387.00 | $6,391.00 | $9,272.00 |
- 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 / $21,335.05 / $21,827.74
| Facility | | $5,000.00 | $21,335.05 | $21,827.74 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $415.18 / $833.70 / $833.70
| Facility | AS | $415.18 | $833.70 | $833.70 |
- 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 |