- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $4,570.88 / $14,454.40
| Facility | | $2,041.74 | $4,570.88 | $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
- $5,754.40 / $6,606.93 / $10,715.19
| Facility | | $5,754.40 | $6,606.93 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $6,918.31 / $13,489.63
| Facility | | $2,398.83 | $6,918.31 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $3,388.44 / $7,943.28
| Facility | | $2,187.76 | $3,388.44 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,019.95 / $5,888.44 / $9,549.93
| Professional | | $3,019.95 | $5,888.44 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,623.41 / $32,359.37 / $32,359.37
| Facility | | $5,623.41 | $32,359.37 | $32,359.37 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $562.34 / $562.34 / $3,235.94
| Facility | AS | $562.34 | $562.34 | $3,235.94 |
- 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 |