- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $15,135.61 / $19,054.61
| Facility | | $954.99 | $15,135.61 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,481.54 / $15,488.17 / $26,302.68
| Facility | | $11,481.54 | $15,488.17 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $3,019.95 / $5,011.87
| Facility | | $2,570.40 | $3,019.95 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $1,949.84 / $5,495.41
| Facility | | $977.24 | $1,949.84 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,041.74 / $15,848.93
| Facility | | $1,000.00 | $2,041.74 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.44 / $2,187.76 / $3,388.44
| Professional | | $1,445.44 | $2,187.76 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,332.54 / $17,378.01 / $25,703.96
| Facility | | $9,332.54 | $17,378.01 | $25,703.96 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,737.80 / $1,737.80 / $2,570.40
| Facility | AS | $1,737.80 | $1,737.80 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $13,803.84 / $17,782.79
| Facility | | $8,912.51 | $13,803.84 | $17,782.79 |