- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $3,742.00 / $12,600.00
| Facility | | $1,000.00 | $3,742.00 | $12,600.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,500.79 / $8,738.79 / $13,807.20
| Facility | | $5,500.79 | $8,738.79 | $13,807.20 |
- 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
- $516.05 / $742.40 / $6,840.79
| Facility | | $516.05 | $742.40 | $6,840.79 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $128.41 / $849.00 / $849.00
| Facility | AS | $128.41 | $849.00 | $849.00 |
- 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 |