- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $3,467.37 / $7,943.28
| Facility | | $1,000.00 | $3,467.37 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,244.36 / $10,715.19 / $11,220.18
| Facility | | $7,244.36 | $10,715.19 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $1,202.26 / $1,548.82
| Facility | | $870.96 | $1,202.26 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $1,621.81 / $1,621.81
| Facility | | $34.67 | $1,621.81 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $162.18 / $162.18 / $162.18
| Facility | AS | $162.18 | $162.18 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $5,011.87 / $15,135.61
| Facility | | $977.24 | $5,011.87 | $15,135.61 |