- 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
- $4,140.21 / $6,492.10 / $10,128.21
| Facility | | $4,140.21 | $6,492.10 | $10,128.21 |
- 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
- $518.46 / $752.40 / $5,558.80
| Facility | | $518.46 | $752.40 | $5,558.80 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $129.69 / $849.00 / $849.00
| Facility | AS | $129.69 | $849.00 | $849.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $884.00 / $3,317.00 / $5,543.93
| Facility | | $884.00 | $3,317.00 | $5,543.93 |