- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,943.13 / $4,337.18 / $17,823.00
| Facility | | $1,943.13 | $4,337.18 | $17,823.00 |
- 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
- $5,436.46 / $6,352.93 / $10,247.04
| Facility | | $5,436.46 | $6,352.93 | $10,247.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,927.64 / $2,515.84 / $4,144.43
| Facility | | $1,927.64 | $2,515.84 | $4,144.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,943.13 / $3,075.31 / $7,700.00
| Facility | | $1,943.13 | $3,075.31 | $7,700.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,927.64 / $2,515.84 / $4,144.43
| Facility | | $1,927.64 | $2,515.84 | $4,144.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,528.55 / $6,967.00 / $9,226.74
| Professional | | $4,528.55 | $6,967.00 | $9,226.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31,503.72 / $31,503.72 / $31,503.72
| Facility | | $31,503.72 | $31,503.72 | $31,503.72 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,054.68 / $1,054.68 / $1,054.68
| Facility | AS | $1,054.68 | $1,054.68 | $1,054.68 |
- 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 |