- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $4,521.00 / $9,842.00
| Facility | | $1,000.00 | $4,521.00 | $9,842.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,432.00 / $8,113.00 / $17,400.00
| Facility | | $4,432.00 | $8,113.00 | $17,400.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,314.66 / $3,626.26 / $4,798.32
| Facility | | $3,314.66 | $3,626.26 | $4,798.32 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $79.52 / $79.52 / $79.52
| Facility | AS | $79.52 | $79.52 | $79.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,062.00 / $8,220.00 / $14,242.22
| Facility | | $4,062.00 | $8,220.00 | $14,242.22 |