- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,501.73 / $2,430.21 / $14,482.00
| Facility | | $1,501.73 | $2,430.21 | $14,482.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,538.00 / $10,196.00 / $17,436.00
| Facility | | $6,538.00 | $10,196.00 | $17,436.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,021.46 / $3,530.81 / $5,695.07
| Facility | | $3,021.46 | $3,530.81 | $5,695.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,188.10 / $1,887.01 / $2,671.65
| Facility | | $1,188.10 | $1,887.01 | $2,671.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,376.61 / $2,678.00 / $7,700.00
| Facility | | $1,376.61 | $2,678.00 | $7,700.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,188.10 / $1,887.01 / $2,671.65
| Facility | | $1,188.10 | $1,887.01 | $2,671.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,453.75 / $3,788.97 / $4,925.08
| Professional | | $2,453.75 | $3,788.97 | $4,925.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,059.04 / $23,059.04 / $23,059.04
| Facility | | $23,059.04 | $23,059.04 | $23,059.04 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $571.47 / $571.47 / $571.47
| Facility | AS | $571.47 | $571.47 | $571.47 |
- 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 |