- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $10,715.19 / $22,908.68
| Facility | | $4,466.84 | $10,715.19 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,220.18 / $16,982.44 / $28,840.32
| Facility | | $11,220.18 | $16,982.44 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $61.66 / $100.00 / $9,332.54
| Facility | | $61.66 | $100.00 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $1,862.09 / $3,019.95
| Professional | | $1,479.11 | $1,862.09 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,089.30 / $2,754.23 / $5,370.32
| Professional | | $2,089.30 | $2,754.23 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.95 / $56.23 / $58,884.37
| Facility | | $54.95 | $56.23 | $58,884.37 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $5,888.44 / $5,888.44 / $5,888.44
| Facility | AS | $5,888.44 | $5,888.44 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $3,162.28 / $4,365.16
| Facility | | $2,454.71 | $3,162.28 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $6,165.95 / $18,620.87
| Facility | | $2,041.74 | $6,165.95 | $18,620.87 |