- 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
- $4,064.77 / $6,457.50 / $10,202.77
| Facility | | $4,064.77 | $6,457.50 | $10,202.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $900.00 / $900.00
| Facility | | $900.00 | $900.00 | $900.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $890.04 / $1,255.50 / $6,710.71
| Facility | | $890.04 | $1,255.50 | $6,710.71 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $224.92 / $1,625.25 / $1,625.25
| Facility | AS | $224.92 | $1,625.25 | $1,625.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,157.00 / $4,424.00 / $7,077.94
| Facility | | $1,157.00 | $4,424.00 | $7,077.94 |