- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,145.78 / $7,838.38
| Facility | | $1,000.00 | $2,145.78 | $7,838.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,553.63 / $13,685.93 / $22,319.96
| Facility | | $5,553.63 | $13,685.93 | $22,319.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $214.31 / $214.31 / $214.31
| Facility | | $214.31 | $214.31 | $214.31 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $20.84 / $20.84 / $20.84
| Facility | AS | $20.84 | $20.84 | $20.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $178.82 / $239.02 / $284.50
| Facility | | $178.82 | $239.02 | $284.50 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $20.84 / $20.84 / $20.84
| Facility | AS | $20.84 | $20.84 | $20.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $200.00 / $1,158.00 / $1,327.00
| Facility | | $200.00 | $1,158.00 | $1,327.00 |