- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $3,802.72 / $12,600.00
| Facility | | $1,000.00 | $3,802.72 | $12,600.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,387.39 / $10,015.81 / $15,625.45
| Facility | | $6,387.39 | $10,015.81 | $15,625.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,545.78 / $2,545.78 / $2,545.78
| Facility | | $2,545.78 | $2,545.78 | $2,545.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $695.88 / $972.33 / $6,240.33
| Facility | | $695.88 | $972.33 | $6,240.33 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $171.81 / $849.00 / $849.00
| Facility | AS | $171.81 | $849.00 | $849.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,157.00 / $4,612.45 / $8,114.35
| Facility | | $1,157.00 | $4,612.45 | $8,114.35 |