- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $4,073.80 / $14,454.40
| Facility | | $1,949.84 | $4,073.80 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $8,128.31 / $13,489.63
| Facility | | $5,011.87 | $8,128.31 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,128.61 / $6,025.60 / $9,549.93
| Facility | | $5,128.61 | $6,025.60 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $3,981.07 / $10,000.00
| Facility | | $1,905.46 | $3,981.07 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $4,073.80 / $15,135.61
| Facility | | $1,905.46 | $4,073.80 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,884.03 / $4,365.16 / $6,760.83
| Professional | | $2,884.03 | $4,365.16 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,128.61 / $14,125.38 / $14,125.38
| Facility | | $5,128.61 | $14,125.38 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $512.86 / $512.86 / $1,412.54
| Facility | AS | $512.86 | $512.86 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,709.64 / $13,489.63 / $17,378.01
| Facility | | $8,709.64 | $13,489.63 | $17,378.01 |