- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $2,570.40 / $14,454.40
| Facility | | $1,513.56 | $2,570.40 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,120.11 / $12,882.50 / $20,417.38
| Facility | | $9,120.11 | $12,882.50 | $20,417.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $3,801.89 / $6,025.60
| Facility | | $3,235.94 | $3,801.89 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $7,244.36 / $14,454.40
| Facility | | $1,479.11 | $7,244.36 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $2,818.38 / $9,549.93
| Facility | | $1,445.44 | $2,818.38 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,659.59 / $3,235.94 / $5,128.61
| Professional | | $1,659.59 | $3,235.94 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $3,235.94 / $23,988.33
| Facility | | $3,235.94 | $3,235.94 | $23,988.33 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $323.59 / $323.59 / $2,398.83
| Facility | AS | $323.59 | $323.59 | $2,398.83 |
- 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 |