- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $5,623.41 / $10,000.00
| Facility | | $1,905.46 | $5,623.41 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $4,897.79 / $10,000.00
| Facility | | $2,238.72 | $4,897.79 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $10,715.19 / $22,908.68
| Facility | | $2,511.89 | $10,715.19 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $2,511.89 / $10,232.93
| Facility | | $1,621.81 | $2,511.89 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $446.68 / $794.33 / $794.33
| Facility | AS | $446.68 | $794.33 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $2,818.38 / $10,471.29
| Facility | | $1,230.27 | $2,818.38 | $10,471.29 |