- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $3,019.95 / $14,454.40
| Facility | | $1,348.96 | $3,019.95 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,748.98 / $16,218.10 / $26,302.68
| Facility | | $11,748.98 | $16,218.10 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,801.89 / $4,466.84 / $7,079.46
| Facility | | $3,801.89 | $4,466.84 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $2,951.21 / $10,000.00
| Facility | | $1,445.44 | $2,951.21 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $3,019.95 / $17,782.79
| Facility | | $1,513.56 | $3,019.95 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,398.83 / $3,630.78 / $5,495.41
| Professional | | $2,398.83 | $3,630.78 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,801.89 / $15,848.93 / $15,848.93
| Facility | | $3,801.89 | $15,848.93 | $15,848.93 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $380.19 / $380.19 / $1,584.89
| Facility | AS | $380.19 | $380.19 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,128.31 / $16,218.10 / $21,379.62
| Facility | | $8,128.31 | $16,218.10 | $21,379.62 |