- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $3,684.00 / $18,600.00
| Facility | | $1,000.00 | $3,684.00 | $18,600.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,324.45 / $11,576.73 / $18,432.97
| Facility | | $7,324.45 | $11,576.73 | $18,432.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $773.00 / $1,292.57 / $5,882.00
| Facility | | $773.00 | $1,292.57 | $5,882.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $403.43 / $403.43 / $403.43
| Facility | AS | $403.43 | $403.43 | $403.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $350.00 / $1,760.00 / $6,155.68
| Facility | | $350.00 | $1,760.00 | $6,155.68 |