- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $8,912.51 / $22,387.21
| Facility | | $3,715.35 | $8,912.51 | $22,387.21 |
- 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 / $13,182.57
| Facility | | $66.07 | $5,128.61 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,918.31 / $6,918.31 / $6,918.31
| Facility | | $6,918.31 | $6,918.31 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $812.83 / $1,096.48
| Professional | | $602.56 | $812.83 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $870.96 / $1,621.81
| Professional | | $660.69 | $870.96 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,952.62 / $33,884.42 / $33,884.42
| Facility | | $19,952.62 | $33,884.42 | $33,884.42 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,995.26 / $1,995.26 / $1,995.26
| Facility | AS | $1,995.26 | $1,995.26 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $977.24 / $1,513.56
| Facility | | $741.31 | $977.24 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,760.83 / $12,302.69 / $25,703.96
| Facility | | $6,760.83 | $12,302.69 | $25,703.96 |