- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $3,218.00 / $8,400.00
| Facility | | $1,000.00 | $3,218.00 | $8,400.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27,326.83 / $43,191.71 / $68,269.22
| Facility | | $27,326.83 | $43,191.71 | $68,269.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $465.70 / $1,832.37 / $32,093.31
| Facility | | $465.70 | $1,832.37 | $32,093.31 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $10,807.58 / $10,807.58 / $10,807.58
| Facility | AS | $10,807.58 | $10,807.58 | $10,807.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,180.00 / $19,870.00 / $32,316.00
| Facility | | $4,180.00 | $19,870.00 | $32,316.00 |