- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $4,073.80 / $18,620.87
| Facility | | $1,000.00 | $4,073.80 | $18,620.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,413.10 / $11,748.98 / $18,620.87
| Facility | | $7,413.10 | $11,748.98 | $18,620.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,413.10 / $7,413.10 / $7,413.10
| Facility | | $7,413.10 | $7,413.10 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $2,187.76 / $14,125.38
| Facility | | $741.31 | $2,187.76 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $186.21 / $2,454.71 / $2,454.71
| Facility | AS | $186.21 | $2,454.71 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $7,762.47 / $14,454.40
| Facility | | $1,949.84 | $7,762.47 | $14,454.40 |