- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $3,683.00 / $8,400.00
| Facility | | $1,000.00 | $3,683.00 | $8,400.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,491.09 / $1,491.09 / $1,491.09
| Facility | | $1,491.09 | $1,491.09 | $1,491.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $677.14 / $978.27 / $5,543.93
| Facility | | $677.14 | $978.27 | $5,543.93 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $194.51 / $497.27 / $497.27
| Facility | AS | $194.51 | $497.27 | $497.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $880.00 / $3,317.00 / $5,543.93
| Facility | | $880.00 | $3,317.00 | $5,543.93 |