- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,168.69 / $10,471.29 / $21,379.62
| Facility | | $4,168.69 | $10,471.29 | $21,379.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $8,128.31 / $15,848.93
| Facility | | $4,570.88 | $8,128.31 | $15,848.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $63.10 / $100.00 / $9,120.11
| Facility | | $63.10 | $100.00 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,905.46 / $2,570.40
| Professional | | $1,047.13 | $1,905.46 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $2,041.74 / $3,890.45
| Professional | | $1,548.82 | $2,041.74 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.95 / $56.23 / $22,387.21
| Facility | | $54.95 | $56.23 | $22,387.21 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $2,238.72 / $2,238.72 / $2,238.72
| Facility | AS | $2,238.72 | $2,238.72 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $2,290.87 / $3,630.78
| Facility | | $1,737.80 | $2,290.87 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,762.47 / $14,125.38 / $28,840.32
| Facility | | $7,762.47 | $14,125.38 | $28,840.32 |