- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $3,467.37 / $14,454.40
| Facility | | $1,659.59 | $3,467.37 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,748.98 / $16,218.10 / $27,542.29
| Facility | | $11,748.98 | $16,218.10 | $27,542.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $5,128.61 / $8,128.31
| Facility | | $4,365.16 | $5,128.61 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $3,467.37 / $10,000.00
| Facility | | $1,698.24 | $3,467.37 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $3,548.13 / $19,498.45
| Facility | | $1,698.24 | $3,548.13 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,754.23 / $4,168.69 / $6,309.57
| Professional | | $2,754.23 | $4,168.69 | $6,309.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $22,387.21 / $22,387.21
| Facility | | $4,365.16 | $22,387.21 | $22,387.21 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $436.52 / $436.52 / $2,238.72
| Facility | AS | $436.52 | $436.52 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,709.64 / $16,982.44 / $22,387.21
| Facility | | $8,709.64 | $16,982.44 | $22,387.21 |