- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $3,683.00 / $8,400.00
| Facility | | $1,000.00 | $3,683.00 | $8,400.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,444.76 / $15,004.39 / $23,706.76
| Facility | | $9,444.76 | $15,004.39 | $23,706.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,535.77 / $17,535.77 / $17,535.77
| Facility | | $17,535.77 | $17,535.77 | $17,535.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $431.52 / $696.59 / $13,541.98
| Facility | | $431.52 | $696.59 | $13,541.98 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $112.50 / $5,848.03 / $5,848.03
| Facility | AS | $112.50 | $5,848.03 | $5,848.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,851.00 / $7,074.00 / $14,587.03
| Facility | | $1,851.00 | $7,074.00 | $14,587.03 |