- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $3,612.00 / $8,400.00
| Facility | | $1,000.00 | $3,612.00 | $8,400.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,858.92 / $9,241.20 / $14,654.94
| Facility | | $5,858.92 | $9,241.20 | $14,654.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $772.62 / $1,120.30 / $3,436.14
| Facility | | $772.62 | $1,120.30 | $3,436.14 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $384.81 / $384.81 / $384.81
| Facility | AS | $384.81 | $384.81 | $384.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.00 / $1,928.00 / $4,012.00
| Facility | | $575.00 | $1,928.00 | $4,012.00 |