- 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
- $7,461.91 / $11,794.01 / $18,778.93
| Facility | | $7,461.91 | $11,794.01 | $18,778.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $172.96 / $251.64 / $5,882.00
| Facility | | $172.96 | $251.64 | $5,882.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $69.48 / $69.48 / $69.48
| Facility | AS | $69.48 | $69.48 | $69.48 |
- 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 |