- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $8,912.51 / $11,748.98
| Facility | | $1,174.90 | $8,912.51 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $6,309.57 / $15,135.61
| Facility | | $1,698.24 | $6,309.57 | $15,135.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,023.29 / $1,288.25
| Facility | | $1,000.00 | $1,023.29 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $1,778.28 / $1,778.28
| Facility | | $34.67 | $1,778.28 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $177.83 / $177.83 / $177.83
| Facility | AS | $177.83 | $177.83 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $1,778.28 / $21,379.62
| Facility | | $426.58 | $1,778.28 | $21,379.62 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $177.83 / $177.83 / $177.83
| Facility | AS | $177.83 | $177.83 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $2,691.53 / $6,760.83
| Facility | | $575.44 | $2,691.53 | $6,760.83 |