- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $4,978.42 / $14,100.00
| Facility | | $1,000.00 | $4,978.42 | $14,100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,700.24 / $8,851.79 / $13,909.96
| Facility | | $5,700.24 | $8,851.79 | $13,909.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $631.90 / $1,125.75 / $7,405.00
| Facility | | $631.90 | $1,125.75 | $7,405.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,196.53 / $1,196.53 / $1,196.53
| Facility | AS | $1,196.53 | $1,196.53 | $1,196.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,157.00 / $4,295.34 / $7,077.94
| Facility | | $1,157.00 | $4,295.34 | $7,077.94 |