- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $4,073.40 / $8,077.00
| Facility | | $1,000.00 | $4,073.40 | $8,077.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,602.87 / $8,785.64 / $13,706.31
| Facility | | $5,602.87 | $8,785.64 | $13,706.31 |
- 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
- $709.74 / $1,012.25 / $11,495.55
| Facility | | $709.74 | $1,012.25 | $11,495.55 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $174.73 / $849.00 / $849.00
| Facility | AS | $174.73 | $849.00 | $849.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,851.00 / $7,074.00 / $14,139.00
| Facility | | $1,851.00 | $7,074.00 | $14,139.00 |