- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $6,456.54 / $12,882.50
| Facility | | $2,238.72 | $6,456.54 | $12,882.50 |
- 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
- $1,023.29 / $1,905.46 / $10,471.29
| Facility | | $1,023.29 | $1,905.46 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $288.40 / $2,511.89 / $2,511.89
| Facility | AS | $288.40 | $2,511.89 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,570.40 / $3,467.37
| Professional | | $2,137.96 | $2,570.40 | $3,467.37 |
- 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 |