- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $3,742.00 / $18,600.00
| Facility | | $1,000.00 | $3,742.00 | $18,600.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,038.84 / $3,222.51 / $5,131.02
| Facility | | $2,038.84 | $3,222.51 | $5,131.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $205.68 / $388.09 / $5,833.89
| Facility | | $205.68 | $388.09 | $5,833.89 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $102.75 / $102.75 / $102.75
| Facility | AS | $102.75 | $102.75 | $102.75 |
- 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 |