- 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
- $5,500.79 / $8,785.64 / $13,884.07
| Facility | | $5,500.79 | $8,785.64 | $13,884.07 |
- 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
- $615.75 / $885.61 / $11,495.55
| Facility | | $615.75 | $885.61 | $11,495.55 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $151.54 / $849.00 / $849.00
| Facility | AS | $151.54 | $849.00 | $849.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,851.00 / $6,980.00 / $14,139.00
| Facility | | $1,851.00 | $6,980.00 | $14,139.00 |