- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,831.20 / $3,111.75 / $14,482.00
| Facility | | $1,831.20 | $3,111.75 | $14,482.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,084.00 / $11,783.00 / $18,458.00
| Facility | | $7,084.00 | $11,783.00 | $18,458.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,899.15 / $4,556.46 / $7,349.41
| Facility | | $3,899.15 | $4,556.46 | $7,349.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,521.30 / $2,142.50 / $2,973.45
| Facility | | $1,521.30 | $2,142.50 | $2,973.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,716.00 / $2,803.00 / $7,868.00
| Facility | | $1,716.00 | $2,803.00 | $7,868.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.60 / $2,142.50 / $2,973.45
| Facility | | $1,659.60 | $2,142.50 | $2,973.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,103.75 / $4,775.00 / $6,058.04
| Professional | | $3,103.75 | $4,775.00 | $6,058.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29,256.16 / $29,256.16 / $29,256.16
| Facility | | $29,256.16 | $29,256.16 | $29,256.16 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $722.85 / $722.85 / $722.85
| Facility | AS | $722.85 | $722.85 | $722.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,203.00 / $4,316.80 / $19,003.00
| Facility | | $2,203.00 | $4,316.80 | $19,003.00 |