- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,818.38 / $6,456.54
| Facility | | $1,000.00 | $2,818.38 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,801.89 / $7,244.36 / $11,220.18
| Facility | | $3,801.89 | $7,244.36 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.20 / $30.20 / $30.20
| Facility | | $30.20 | $30.20 | $30.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $19,952.62 / $19,952.62
| Facility | | $5,011.87 | $19,952.62 | $19,952.62 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,995.26 / $1,995.26 / $1,995.26
| Facility | AS | $1,995.26 | $1,995.26 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $7,585.78 / $12,022.64
| Facility | | $4,365.16 | $7,585.78 | $12,022.64 |