- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $3,684.00 / $8,400.00
| Facility | | $1,000.00 | $3,684.00 | $8,400.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,784.42 / $5,985.66 / $9,524.00
| Facility | | $3,784.42 | $5,985.66 | $9,524.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,142.82 / $7,142.82 / $7,142.82
| Facility | | $7,142.82 | $7,142.82 | $7,142.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $681.59 / $1,138.25 / $7,567.45
| Facility | | $681.59 | $1,138.25 | $7,567.45 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $195.85 / $2,382.07 / $2,382.07
| Facility | AS | $195.85 | $2,382.07 | $2,382.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,481.00 / $5,524.00 / $9,232.95
| Facility | | $1,481.00 | $5,524.00 | $9,232.95 |