- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $4,168.69 / $14,454.40
| Facility | | $1,995.26 | $4,168.69 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,748.98 / $15,488.17 / $26,302.68
| Facility | | $11,748.98 | $15,488.17 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,248.07 / $6,165.95 / $9,772.37
| Facility | | $5,248.07 | $6,165.95 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $4,168.69 / $10,000.00
| Facility | | $2,041.74 | $4,168.69 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $4,365.16 / $19,498.45
| Facility | | $2,041.74 | $4,365.16 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,090.30 / $4,677.35 / $7,079.46
| Professional | | $3,090.30 | $4,677.35 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,248.07 / $33,113.11 / $33,113.11
| Facility | | $5,248.07 | $33,113.11 | $33,113.11 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $524.81 / $524.81 / $3,311.31
| Facility | AS | $524.81 | $524.81 | $3,311.31 |
- 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 |