- 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
- $19,149.64 / $30,204.58 / $48,066.43
| Facility | | $19,149.64 | $30,204.58 | $48,066.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $214.70 / $690.00 / $5,882.00
| Facility | | $214.70 | $690.00 | $5,882.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $82.96 / $82.96 / $82.96
| Facility | AS | $82.96 | $82.96 | $82.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $350.00 / $1,723.87 / $6,155.68
| Facility | | $350.00 | $1,723.87 | $6,155.68 |