- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $4,677.35 / $10,715.19
| Facility | | $1,000.00 | $4,677.35 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $398.11 / $426.58
| Facility | | $34.67 | $398.11 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $42.66 / $42.66 / $42.66
| Facility | AS | $42.66 | $42.66 | $42.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $12,022.64 / $22,908.68
| Facility | | $6,165.95 | $12,022.64 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $10,232.93 / $15,848.93
| Facility | | $3,311.31 | $10,232.93 | $15,848.93 |