- 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
- $671.22 / $1,151.94 / $7,223.00
| Facility | | $671.22 | $1,151.94 | $7,223.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $357.26 / $357.26 / $357.26
| Facility | AS | $357.26 | $357.26 | $357.26 |
- 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 |