- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $2,630.27 / $14,454.40
| Facility | | $1,621.81 | $2,630.27 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,000.00 / $13,803.84 / $21,877.62
| Facility | | $10,000.00 | $13,803.84 | $21,877.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $3,801.89 / $6,165.95
| Facility | | $3,311.31 | $3,801.89 | $6,165.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $7,413.10 / $14,454.40
| Facility | | $1,479.11 | $7,413.10 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $3,388.44 / $9,549.93
| Facility | | $1,479.11 | $3,388.44 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,344.23 / $3,311.31 / $5,495.41
| Professional | | $2,344.23 | $3,311.31 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $3,311.31 / $23,988.33
| Facility | | $3,311.31 | $3,311.31 | $23,988.33 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $331.13 / $331.13 / $2,398.83
| Facility | AS | $331.13 | $331.13 | $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 |