- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $5,000.27 / $10,417.60
| Facility | | $1,000.00 | $5,000.27 | $10,417.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,498.24 / $8,620.78 / $14,059.36
| Facility | | $3,498.24 | $8,620.78 | $14,059.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $929.72 / $929.72 / $1,656.16
| Facility | | $929.72 | $929.72 | $1,656.16 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $92.27 / $92.27 / $92.27
| Facility | AS | $92.27 | $92.27 | $92.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.19 / $926.93 / $1,259.54
| Facility | | $776.19 | $926.93 | $1,259.54 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $92.27 / $92.27 / $92.27
| Facility | AS | $92.27 | $92.27 | $92.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.00 / $9,127.00 / $10,150.00
| Facility | | $1,230.00 | $9,127.00 | $10,150.00 |