- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $1,000.00 / $11,748.98
| Facility | | $954.99 | $1,000.00 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,754.40 / $35,481.34 / $83,176.38
| Facility | | $5,754.40 | $35,481.34 | $83,176.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $3,467.37 / $8,317.64
| Facility | | $2,454.71 | $3,467.37 | $8,317.64 |
- 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
- $2,691.53 / $3,311.31 / $6,456.54
| Facility | | $2,691.53 | $3,311.31 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,949.84 / $12,022.64
| Facility | | $1,023.29 | $1,949.84 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $9,332.54 / $30,199.52
| Facility | | $1,584.89 | $9,332.54 | $30,199.52 |