- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $5,000.27 / $7,838.38
| Facility | | $1,000.00 | $5,000.27 | $7,838.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,253.82 / $11,267.09 / $17,940.02
| Facility | | $3,253.82 | $11,267.09 | $17,940.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $786.77 / $786.77 / $1,656.16
| Facility | | $786.77 | $786.77 | $1,656.16 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $77.44 / $77.44 / $77.44
| Facility | AS | $77.44 | $77.44 | $77.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $654.77 / $802.39 / $1,014.64
| Facility | | $654.77 | $802.39 | $1,014.64 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $77.44 / $77.44 / $77.44
| Facility | AS | $77.44 | $77.44 | $77.44 |
- 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 |