- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,007.52 / $5,520.00 / $11,627.00
| Facility | | $1,007.52 | $5,520.00 | $11,627.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,315.00 / $7,946.96 / $14,996.00
| Facility | | $3,315.00 | $7,946.96 | $14,996.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.49 / $1,091.45 / $1,589.30
| Facility | | $1,000.49 | $1,091.45 | $1,589.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,571.00 / $21,571.00 / $21,571.00
| Facility | | $21,571.00 | $21,571.00 | $21,571.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,271.82 / $1,271.82 / $1,271.82
| Facility | | $1,271.82 | $1,271.82 | $1,271.82 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $126.39 / $126.39 / $126.39
| Facility | AS | $126.39 | $126.39 | $126.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,480.00 / $3,086.00 / $6,111.00
| Facility | | $1,480.00 | $3,086.00 | $6,111.00 |