- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $3,715.35 / $14,454.40
| Facility | | $1,000.00 | $3,715.35 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $4,168.69 / $9,332.54
| Facility | | $2,511.89 | $4,168.69 | $9,332.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $4,265.80 / $4,265.80
| Facility | | $2,187.76 | $4,265.80 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.95 / $56.23 / $54,954.09
| Facility | | $54.95 | $56.23 | $54,954.09 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $5,495.41 / $5,495.41 / $5,495.41
| Facility | AS | $5,495.41 | $5,495.41 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $3,162.28 / $6,918.31
| Facility | | $1,737.80 | $3,162.28 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $3,090.30 / $5,495.41
| Facility | | $2,344.23 | $3,090.30 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $2,454.71 / $10,232.93
| Facility | | $436.52 | $2,454.71 | $10,232.93 |