- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $3,235.94 / $14,454.40
| Facility | | $1,905.46 | $3,235.94 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,120.11 / $12,882.50 / $23,442.29
| Facility | | $9,120.11 | $12,882.50 | $23,442.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $4,677.35 / $7,413.10
| Facility | | $3,981.07 | $4,677.35 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $5,128.61 / $9,549.93
| Facility | | $1,698.24 | $5,128.61 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $10,715.19 / $19,952.62
| Facility | | $1,698.24 | $10,715.19 | $19,952.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,041.74 / $3,981.07 / $6,309.57
| Professional | | $2,041.74 | $3,981.07 | $6,309.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $29,512.09 / $29,512.09
| Facility | | $3,981.07 | $29,512.09 | $29,512.09 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $398.11 / $398.11 / $2,951.21
| Facility | AS | $398.11 | $398.11 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,128.31 / $16,218.10 / $21,379.62
| Facility | | $8,128.31 | $16,218.10 | $21,379.62 |