- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $10,715.19 / $22,908.68
| Facility | | $4,466.84 | $10,715.19 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,943.28 / $13,803.84 / $22,387.21
| Facility | | $7,943.28 | $13,803.84 | $22,387.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $60.26 / $100.00 / $12,882.50
| Facility | | $60.26 | $100.00 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,698.24 / $2,511.89 / $3,388.44
| Professional | | $1,698.24 | $2,511.89 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,454.71 / $3,235.94 / $6,165.95
| Professional | | $2,454.71 | $3,235.94 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- 80
- Low / Median / High Price
- $501.19 / $501.19 / $501.19
| Professional | 80 | $501.19 | $501.19 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.95 / $56.23 / $37,153.52
| Facility | | $54.95 | $56.23 | $37,153.52 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $3,715.35 / $3,715.35 / $3,715.35
| Facility | AS | $3,715.35 | $3,715.35 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $3,548.13 / $5,370.32
| Facility | | $2,754.23 | $3,548.13 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $6,165.95 / $18,620.87
| Facility | | $1,995.26 | $6,165.95 | $18,620.87 |