- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,497.83 / $8,439.00 / $36,952.23
| Facility | | $3,497.83 | $8,439.00 | $36,952.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,363.30 / $1,832.80 / $3,233.30
| Professional | | $1,363.30 | $1,832.80 | $3,233.30 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $209.53 / $367.47 / $946.33
| Professional | AS | $209.53 | $367.47 | $946.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,431.24 / $17,431.24 / $17,480.24
| Facility | | $17,431.24 | $17,431.24 | $17,480.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,626.96 / $2,191.80 / $2,535.21
| Professional | | $1,626.96 | $2,191.80 | $2,535.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,387.24 / $2,679.50 / $3,527.23
| Facility | | $1,387.24 | $2,679.50 | $3,527.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,334.48 / $2,546.71 / $3,357.34
| Professional | | $2,334.48 | $2,546.71 | $3,357.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $1,996.06 / $2,253.62
| Professional | | $32.34 | $1,996.06 | $2,253.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,890.63 / $36,978.26 / $58,702.26
| Facility | | $23,890.63 | $36,978.26 | $58,702.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,460.42 / $2,894.61 / $3,357.34
| Professional | | $2,460.42 | $2,894.61 | $3,357.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,800.00 / $12,000.00 / $45,126.00
| Facility | | $4,800.00 | $12,000.00 | $45,126.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,590.25 / $2,200.66 / $3,232.21
| Professional | | $1,590.25 | $2,200.66 | $3,232.21 |