- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $3,981.07 / $14,454.40
| Facility | | $1,778.28 | $3,981.07 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,748.98 / $16,218.10 / $27,542.29
| Facility | | $11,748.98 | $16,218.10 | $27,542.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $5,754.40 / $9,120.11
| Facility | | $4,897.79 | $5,754.40 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $6,918.31 / $13,489.63
| Facility | | $2,089.30 | $6,918.31 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $3,548.13 / $7,943.28
| Facility | | $1,905.46 | $3,548.13 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,630.27 / $5,128.61 / $8,128.31
| Professional | | $2,630.27 | $5,128.61 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $25,703.96 / $25,703.96
| Facility | | $4,897.79 | $25,703.96 | $25,703.96 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $489.78 / $489.78 / $2,570.40
| Facility | AS | $489.78 | $489.78 | $2,570.40 |
- 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 |