- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,818.38 / $8,511.38
| Facility | | $1,000.00 | $2,818.38 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $7,585.78 / $14,454.40
| Facility | | $2,238.72 | $7,585.78 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,182.57 / $16,218.10 / $16,218.10
| Facility | | $13,182.57 | $16,218.10 | $16,218.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $524.81 / $5,370.32
| Facility | | $309.03 | $524.81 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $79.43 / $151.36 / $151.36
| Facility | AS | $79.43 | $151.36 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $707.95 / $9,549.93
| Facility | | $338.84 | $707.95 | $9,549.93 |