- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $30,902.95 / $34,673.69
| Facility | | $1,348.96 | $30,902.95 | $34,673.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,120.11 / $12,882.50 / $22,387.21
| Facility | | $9,120.11 | $12,882.50 | $22,387.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $3,981.07 / $6,309.57
| Facility | | $3,388.44 | $3,981.07 | $6,309.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $7,079.46 / $13,489.63
| Facility | | $1,445.44 | $7,079.46 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $2,818.38 / $7,943.28
| Facility | | $1,445.44 | $2,818.38 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $3,019.95 / $5,128.61
| Professional | | $1,548.82 | $3,019.95 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $12,022.64 / $12,022.64
| Facility | | $3,388.44 | $12,022.64 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $338.84 / $338.84 / $1,202.26
| Facility | AS | $338.84 | $338.84 | $1,202.26 |
- 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 |