- 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
- $4,128.68 / $6,457.50 / $10,128.21
| Facility | | $4,128.68 | $6,457.50 | $10,128.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,659.86 / $5,659.86 / $5,659.86
| Facility | | $5,659.86 | $5,659.86 | $5,659.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $651.19 / $913.00 / $6,889.15
| Facility | | $651.19 | $913.00 | $6,889.15 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $158.81 / $1,887.52 / $1,887.52
| Facility | AS | $158.81 | $1,887.52 | $1,887.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,157.00 / $4,424.00 / $9,062.00
| Facility | | $1,157.00 | $4,424.00 | $9,062.00 |