- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $9,549.93 / $23,988.33
| Facility | | $3,548.13 | $9,549.93 | $23,988.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,025.60 / $10,715.19 / $17,782.79
| Facility | | $6,025.60 | $10,715.19 | $17,782.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $66.07 / $5,128.61 / $14,791.08
| Facility | | $66.07 | $5,128.61 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,782.79 / $17,782.79 / $17,782.79
| Facility | | $17,782.79 | $17,782.79 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,122.02 / $1,513.56
| Professional | | $831.76 | $1,122.02 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,230.27 / $2,398.83
| Professional | | $912.01 | $1,230.27 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33,884.42 / $33,884.42 / $51,286.14
| Facility | | $33,884.42 | $33,884.42 | $51,286.14 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $5,128.61 / $5,128.61 / $5,128.61
| Facility | AS | $5,128.61 | $5,128.61 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,380.38 / $2,137.96
| Facility | | $1,047.13 | $1,380.38 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,762.47 / $14,125.38 / $28,840.32
| Facility | | $7,762.47 | $14,125.38 | $28,840.32 |