- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $2,570.40 / $14,454.40
| Facility | | $1,621.81 | $2,570.40 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,882.50 / $18,197.01 / $30,199.52
| Facility | | $12,882.50 | $18,197.01 | $30,199.52 |
- 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 / $7,413.10 / $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
- $2,238.72 / $3,162.28 / $5,370.32
| Professional | | $2,238.72 | $3,162.28 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $3,235.94 / $16,595.87
| Facility | | $3,235.94 | $3,235.94 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $323.59 / $323.59 / $1,659.59
| Facility | AS | $323.59 | $323.59 | $1,659.59 |
- 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 |