- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $10,964.78 / $19,054.61
| Facility | | $1,862.09 | $10,964.78 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $10,964.78 / $17,378.01
| Facility | | $6,606.93 | $10,964.78 | $17,378.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $2,754.23 / $4,466.84
| Facility | | $2,398.83 | $2,754.23 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $6,918.31 / $13,489.63
| Facility | | $1,000.00 | $6,918.31 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $7,244.36 / $12,589.25
| Facility | | $1,000.00 | $7,244.36 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $2,089.30 / $2,884.03
| Professional | | $1,071.52 | $2,089.30 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,511.38 / $12,589.25 / $12,589.25
| Facility | | $8,511.38 | $12,589.25 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $851.14 / $851.14 / $1,258.93
| Facility | AS | $851.14 | $851.14 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $10,232.93 / $13,182.57
| Facility | | $6,606.93 | $10,232.93 | $13,182.57 |