- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,258.00 / $3,963.75 / $7,602.00
| Facility | | $2,258.00 | $3,963.75 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,275.00 / $2,326.00 / $4,528.00
| Facility | | $1,275.00 | $2,326.00 | $4,528.00 |
- 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 / $26,015.66 / $26,682.04
| Facility | | $5,000.00 | $26,015.66 | $26,682.04 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $502.82 / $1,013.65 / $1,013.65
| Facility | AS | $502.82 | $1,013.65 | $1,013.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,233.00 / $2,665.00 / $4,918.00
| Facility | | $1,233.00 | $2,665.00 | $4,918.00 |