- 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
- $5,858.92 / $9,241.20 / $14,654.94
| Facility | | $5,858.92 | $9,241.20 | $14,654.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.14 / $116.78 / $1,470.67
| Facility | | $80.14 | $116.78 | $1,470.67 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $37.69 / $37.69 / $37.69
| Facility | AS | $37.69 | $37.69 | $37.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $139.00 / $727.00 / $1,582.00
| Facility | | $139.00 | $727.00 | $1,582.00 |