- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,786.30 / $8,511.38 / $16,218.10
| Facility | | $4,786.30 | $8,511.38 | $16,218.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,748.98 / $15,488.17 / $30,199.52
| Facility | | $11,748.98 | $15,488.17 | $30,199.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,182.57 / $13,182.57 / $13,182.57
| Facility | | $13,182.57 | $13,182.57 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $2,398.83 / $15,488.17
| Facility | | $1,380.38 | $2,398.83 | $15,488.17 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $389.05 / $741.31 / $741.31
| Facility | AS | $389.05 | $741.31 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,884.03 / $3,467.37 / $4,897.79
| Professional | | $2,884.03 | $3,467.37 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,182.57 / $13,182.57 / $13,182.57
| Facility | | $13,182.57 | $13,182.57 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,709.64 / $13,489.63 / $19,498.45
| Facility | | $8,709.64 | $13,489.63 | $19,498.45 |