- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $9,549.93 / $22,908.68
| Facility | | $3,630.78 | $9,549.93 | $22,908.68 |
- 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 / $14,791.08
| Facility | | $66.07 | $5,128.61 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,498.45 / $19,498.45 / $19,498.45
| Facility | | $19,498.45 | $19,498.45 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $851.14 / $1,148.15
| Professional | | $588.84 | $851.14 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $912.01 / $1,659.59
| Professional | | $691.83 | $912.01 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33,884.42 / $33,884.42 / $56,234.13
| Facility | | $33,884.42 | $33,884.42 | $56,234.13 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $5,623.41 / $5,623.41 / $5,623.41
| Facility | AS | $5,623.41 | $5,623.41 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $1,000.00 / $1,548.82
| Facility | | $776.25 | $1,000.00 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,762.47 / $14,125.38 / $28,840.32
| Facility | | $7,762.47 | $14,125.38 | $28,840.32 |