- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $1,412.54 / $10,471.29
| Facility | | $660.69 | $1,412.54 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $8,128.31 / $13,489.63
| Facility | | $5,011.87 | $8,128.31 | $13,489.63 |
- 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 / $2,951.21 / $10,000.00
| Facility | | $1,445.44 | $2,951.21 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $3,090.30 / $19,498.45
| Facility | | $1,445.44 | $3,090.30 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,344.23 / $3,548.13 / $5,495.41
| Professional | | $2,344.23 | $3,548.13 | $5,495.41 |
- 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
- $8,709.64 / $16,982.44 / $22,387.21
| Facility | | $8,709.64 | $16,982.44 | $22,387.21 |