- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,819.70 / $14,454.40
| Facility | | $1,071.52 | $1,819.70 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,882.50 / $18,197.01 / $28,840.32
| Facility | | $12,882.50 | $18,197.01 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $2,630.27 / $4,265.80
| Facility | | $2,238.72 | $2,630.27 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $7,244.36 / $14,454.40
| Facility | | $1,023.29 | $7,244.36 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $2,818.38 / $9,549.93
| Facility | | $1,023.29 | $2,818.38 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $2,238.72 / $3,548.13
| Professional | | $1,174.90 | $2,238.72 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $2,290.87 / $16,595.87
| Facility | | $2,290.87 | $2,290.87 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $229.09 / $229.09 / $1,659.59
| Facility | AS | $229.09 | $229.09 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $6,165.95 / $19,498.45
| Facility | | $2,290.87 | $6,165.95 | $19,498.45 |