- 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
- $4,784.82 / $7,547.05 / $11,968.30
| Facility | | $4,784.82 | $7,547.05 | $11,968.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.60 / $973.20 / $4,715.00
| Facility | | $676.60 | $973.20 | $4,715.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $382.77 / $382.77 / $382.77
| Facility | AS | $382.77 | $382.77 | $382.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $884.00 / $2,900.00 / $5,543.93
| Facility | | $884.00 | $2,900.00 | $5,543.93 |