- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,982.11 / $4,155.43 / $14,482.00
| Facility | | $1,982.11 | $4,155.43 | $14,482.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,499.00 / $16,401.00 / $37,855.00
| Facility | | $11,499.00 | $16,401.00 | $37,855.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,234.60 / $6,117.05 / $9,383.70
| Facility | | $5,234.60 | $6,117.05 | $9,383.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,982.11 / $2,954.98 / $4,410.00
| Facility | | $1,982.11 | $2,954.98 | $4,410.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,994.47 / $4,061.35 / $16,976.00
| Facility | | $1,994.47 | $4,061.35 | $16,976.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,982.11 / $2,895.40 / $4,410.00
| Facility | | $1,982.11 | $2,895.40 | $4,410.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,152.85 / $5,060.09 / $7,553.71
| Professional | | $4,152.85 | $5,060.09 | $7,553.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34,326.74 / $34,326.74 / $34,326.74
| Facility | | $34,326.74 | $34,326.74 | $34,326.74 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $967.18 / $967.18 / $967.18
| Facility | AS | $967.18 | $967.18 | $967.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,650.00 / $14,566.00 / $19,562.00
| Facility | | $8,650.00 | $14,566.00 | $19,562.00 |