- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $3,821.00 / $12,600.00
| Facility | | $1,000.00 | $3,821.00 | $12,600.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,175.22 / $6,585.53 / $10,443.50
| Facility | | $4,175.22 | $6,585.53 | $10,443.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $423.50 / $613.49 / $7,584.00
| Facility | | $423.50 | $613.49 | $7,584.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,568.44 / $1,568.44 / $1,568.44
| Facility | AS | $1,568.44 | $1,568.44 | $1,568.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,481.00 / $5,407.00 / $9,232.95
| Facility | | $1,481.00 | $5,407.00 | $9,232.95 |