- 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
- $8,666.79 / $13,768.47 / $21,754.02
| Facility | | $8,666.79 | $13,768.47 | $21,754.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,980.81 / $4,980.81 / $4,980.81
| Facility | | $4,980.81 | $4,980.81 | $4,980.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $902.80 / $1,458.25 / $8,753.15
| Facility | | $902.80 | $1,458.25 | $8,753.15 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $251.53 / $1,661.06 / $1,661.06
| Facility | AS | $251.53 | $1,661.06 | $1,661.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.00 / $6,627.00 / $10,811.00
| Facility | | $1,862.00 | $6,627.00 | $10,811.00 |