- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,361.48 / $5,271.57 / $14,482.00
| Facility | | $2,361.48 | $5,271.57 | $14,482.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,499.00 / $16,401.00 / $25,162.36
| Facility | | $11,499.00 | $16,401.00 | $25,162.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,614.22 / $7,729.24 / $12,466.99
| Facility | | $6,614.22 | $7,729.24 | $12,466.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,361.48 / $3,593.78 / $8,679.20
| Facility | | $2,361.48 | $3,593.78 | $8,679.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,424.21 / $3,735.26 / $8,679.20
| Facility | | $2,424.21 | $3,735.26 | $8,679.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,361.48 / $3,593.78 / $8,679.20
| Facility | | $2,361.48 | $3,593.78 | $8,679.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,495.75 / $8,455.00 / $11,148.07
| Professional | | $5,495.75 | $8,455.00 | $11,148.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $38,277.36 / $38,277.36 / $38,277.36
| Facility | | $38,277.36 | $38,277.36 | $38,277.36 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,279.93 / $1,279.93 / $1,279.93
| Facility | AS | $1,279.93 | $1,279.93 | $1,279.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,203.00 / $4,316.80 / $19,003.00
| Facility | | $2,203.00 | $4,316.80 | $19,003.00 |