- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $3,683.00 / $13,403.66
| Facility | | $1,000.00 | $3,683.00 | $13,403.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,424.51 / $10,227.10 / $15,653.51
| Facility | | $7,424.51 | $10,227.10 | $15,653.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $357.33 / $477.23 / $800.23
| Facility | | $357.33 | $477.23 | $800.23 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,537.78 / $1,537.78 / $1,537.78
| Facility | AS | $1,537.78 | $1,537.78 | $1,537.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,990.00 / $6,100.00 / $11,050.00
| Facility | | $3,990.00 | $6,100.00 | $11,050.00 |