- 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
- $5,179.38 / $8,169.40 / $13,000.47
| Facility | | $5,179.38 | $8,169.40 | $13,000.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $350.00 / $1,094.00 / $5,882.00
| Facility | | $350.00 | $1,094.00 | $5,882.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $159.86 / $159.86 / $159.86
| Facility | AS | $159.86 | $159.86 | $159.86 |
- 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 |