- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,114.21 / $5,046.32 / $14,482.00
| Facility | | $3,114.21 | $5,046.32 | $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
- $6,293.42 / $7,354.36 / $11,862.32
| Facility | | $6,293.42 | $7,354.36 | $11,862.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,467.09 / $3,898.04 / $5,565.00
| Facility | | $2,467.09 | $3,898.04 | $5,565.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,467.09 / $3,898.04 / $9,547.50
| Facility | | $2,467.09 | $3,898.04 | $9,547.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,467.09 / $3,898.04 / $5,565.00
| Facility | | $2,467.09 | $3,898.04 | $5,565.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,053.10 / $7,802.76 / $10,220.89
| Professional | | $5,053.10 | $7,802.76 | $10,220.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56,497.64 / $56,497.64 / $56,497.64
| Facility | | $56,497.64 | $56,497.64 | $56,497.64 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,176.83 / $1,176.83 / $1,176.83
| Facility | AS | $1,176.83 | $1,176.83 | $1,176.83 |
- 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 |