- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $4,570.88 / $11,481.54
| Facility | | $1,000.00 | $4,570.88 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $8,511.38 / $20,417.38
| Facility | | $2,630.27 | $8,511.38 | $20,417.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $2,187.76 / $6,309.57
| Facility | | $1,230.27 | $2,187.76 | $6,309.57 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $123.03 / $123.03 / $123.03
| Facility | AS | $123.03 | $123.03 | $123.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $8,709.64 / $19,054.61
| Facility | | $3,019.95 | $8,709.64 | $19,054.61 |