- 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
- $816.10 / $1,166.55 / $4,732.20
| Facility | | $816.10 | $1,166.55 | $4,732.20 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $388.90 / $388.90 / $388.90
| Facility | AS | $388.90 | $388.90 | $388.90 |
- 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 |