- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,254.50 / $5,268.40 / $14,482.00
| Facility | | $3,254.50 | $5,268.40 | $14,482.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,080.00 / $17,505.00 / $23,937.00
| Facility | | $12,080.00 | $17,505.00 | $23,937.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,567.36 / $7,674.48 / $12,378.67
| Facility | | $6,567.36 | $7,674.48 | $12,378.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,575.66 / $4,074.52 / $5,732.38
| Facility | | $2,575.66 | $4,074.52 | $5,732.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,429.00 / $4,074.52 / $7,700.00
| Facility | | $2,429.00 | $4,074.52 | $7,700.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,575.66 / $4,074.52 / $5,732.38
| Facility | | $2,575.66 | $4,074.52 | $5,732.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,272.80 / $8,142.01 / $10,669.85
| Professional | | $5,272.80 | $8,142.01 | $10,669.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $65,213.82 / $65,213.82 / $65,213.82
| Facility | | $65,213.82 | $65,213.82 | $65,213.82 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,228.01 / $1,228.01 / $1,228.01
| Facility | AS | $1,228.01 | $1,228.01 | $1,228.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,203.00 / $4,316.80 / $19,003.00
| Facility | | $2,203.00 | $4,316.80 | $19,003.00 |