- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $8,511.38 / $21,877.62
| Facility | | $1,862.09 | $8,511.38 | $21,877.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,128.31 / $10,715.19 / $20,892.96
| Facility | | $8,128.31 | $10,715.19 | $20,892.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,244.36 / $7,244.36 / $7,244.36
| Facility | | $7,244.36 | $7,244.36 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $1,513.56 / $10,471.29
| Facility | | $831.76 | $1,513.56 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $234.42 / $2,511.89 / $2,511.89
| Facility | AS | $234.42 | $2,511.89 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,737.80 / $2,041.74 / $2,818.38
| Professional | | $1,737.80 | $2,041.74 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,244.36 / $7,244.36 / $7,244.36
| Facility | | $7,244.36 | $7,244.36 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,918.31 / $8,511.38 / $10,000.00
| Facility | | $6,918.31 | $8,511.38 | $10,000.00 |