- 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
- $8,588.83 / $13,547.08 / $21,483.29
| Facility | | $8,588.83 | $13,547.08 | $21,483.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,321.00 / $2,321.00 / $2,321.00
| Facility | | $2,321.00 | $2,321.00 | $2,321.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $160.43 / $230.32 / $4,073.00
| Facility | | $160.43 | $230.32 | $4,073.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $70.70 / $70.70 / $70.70
| Facility | AS | $70.70 | $70.70 | $70.70 |
- 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 |