- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $3,311.31 / $10,232.93
| Facility | | $1,000.00 | $3,311.31 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $9,772.37 / $19,498.45
| Facility | | $2,884.03 | $9,772.37 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $2,884.03 / $11,481.54
| Facility | | $512.86 | $2,884.03 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $165.96 / $165.96 / $165.96
| Facility | AS | $165.96 | $165.96 | $165.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.15 / $1,202.26 / $5,495.41
| Facility | | $269.15 | $1,202.26 | $5,495.41 |