- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,200.00 / $3,803.00 / $12,600.00
| Facility | | $1,200.00 | $3,803.00 | $12,600.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,478.98 / $17,827.98 / $27,902.91
| Facility | | $11,478.98 | $17,827.98 | $27,902.91 |
- 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
- $1,513.75 / $2,146.82 / $5,833.89
| Facility | | $1,513.75 | $2,146.82 | $5,833.89 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $750.25 / $750.25 / $750.25
| Facility | AS | $750.25 | $750.25 | $750.25 |
- 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 |