- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $2,951.21 / $14,454.40
| Facility | | $1,412.54 | $2,951.21 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $7,943.28 / $13,182.57
| Facility | | $5,011.87 | $7,943.28 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $4,365.16 / $6,918.31
| Facility | | $3,715.35 | $4,365.16 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $2,818.38 / $5,623.41
| Facility | | $1,445.44 | $2,818.38 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $2,951.21 / $14,125.38
| Facility | | $1,445.44 | $2,951.21 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,344.23 / $3,467.37 / $5,370.32
| Professional | | $2,344.23 | $3,467.37 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $19,054.61 / $19,054.61
| Facility | | $3,715.35 | $19,054.61 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $371.54 / $371.54 / $1,905.46
| Facility | AS | $371.54 | $371.54 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $13,803.84 / $17,782.79
| Facility | | $8,912.51 | $13,803.84 | $17,782.79 |