- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,630.27 / $6,606.93
| Facility | | $1,000.00 | $2,630.27 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $2,290.87 / $4,073.80
| Facility | | $1,737.80 | $2,290.87 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $4,466.84 / $13,489.63
| Facility | | $691.83 | $4,466.84 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,318.26 / $1,318.26 / $1,318.26
| Facility | AS | $1,318.26 | $1,318.26 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $7,762.47 / $14,125.38
| Facility | | $1,949.84 | $7,762.47 | $14,125.38 |