- 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
- $5,843.56 / $9,236.09 / $14,706.11
| Facility | | $5,843.56 | $9,236.09 | $14,706.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $763.61 / $1,267.50 / $5,882.00
| Facility | | $763.61 | $1,267.50 | $5,882.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $406.46 / $406.46 / $406.46
| Facility | AS | $406.46 | $406.46 | $406.46 |
- 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 |