- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $10,000.00 / $18,197.01
| Facility | | $4,677.35 | $10,000.00 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $9,332.54 / $17,782.79
| Facility | | $2,187.76 | $9,332.54 | $17,782.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $891.25 / $3,019.95
| Facility | | $891.25 | $891.25 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $302.00 / $302.00 / $302.00
| Facility | AS | $302.00 | $302.00 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,951.21 / $2,951.21 / $4,168.69
| Professional | | $2,951.21 | $2,951.21 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $2,344.23 / $3,981.07
| Facility | | $1,737.80 | $2,344.23 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $20,417.38 / $25,703.96
| Facility | | $4,677.35 | $20,417.38 | $25,703.96 |