- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $3,683.00 / $12,600.00
| Facility | | $1,000.00 | $3,683.00 | $12,600.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,610.62 / $5,647.22 / $8,857.35
| Facility | | $3,610.62 | $5,647.22 | $8,857.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,141.83 / $1,141.83 / $1,141.83
| Facility | | $1,141.83 | $1,141.83 | $1,141.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $434.89 / $616.26 / $5,543.93
| Facility | | $434.89 | $616.26 | $5,543.93 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $108.42 / $380.79 / $380.79
| Facility | AS | $108.42 | $380.79 | $380.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $875.00 / $3,317.00 / $5,543.93
| Facility | | $875.00 | $3,317.00 | $5,543.93 |