- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $5,128.61 / $11,220.18
| Facility | | $1,288.25 | $5,128.61 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,754.40 / $5,754.40 / $8,128.31
| Facility | | $5,754.40 | $5,754.40 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $741.31 / $741.31
| Facility | | $741.31 | $741.31 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,621.81 / $1,621.81 / $2,187.76
| Professional | | $1,621.81 | $1,621.81 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $1,258.93 / $1,949.84
| Facility | | $912.01 | $1,258.93 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,025.60 / $14,791.08 / $22,908.68
| Facility | | $6,025.60 | $14,791.08 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33,884.42 / $54,954.09 / $54,954.09
| Facility | | $33,884.42 | $54,954.09 | $54,954.09 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $5,495.41 / $5,495.41 / $5,495.41
| Facility | AS | $5,495.41 | $5,495.41 | $5,495.41 |