- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $3,367.80 / $8,400.00
| Facility | | $1,000.00 | $3,367.80 | $8,400.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,507.25 / $7,109.23 / $11,273.99
| Facility | | $4,507.25 | $7,109.23 | $11,273.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.88 / $977.60 / $5,781.94
| Facility | | $691.88 | $977.60 | $5,781.94 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $751.59 / $751.59 / $751.59
| Facility | AS | $751.59 | $751.59 | $751.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,157.00 / $4,054.00 / $7,077.94
| Facility | | $1,157.00 | $4,054.00 | $7,077.94 |