- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $10,471.29 / $18,197.01
| Facility | | $1,995.26 | $10,471.29 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $6,760.83 / $12,302.69
| Facility | | $2,884.03 | $6,760.83 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $1,096.48 / $5,754.40
| Facility | | $707.95 | $1,096.48 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $128.82 / $128.82 / $128.82
| Facility | AS | $128.82 | $128.82 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,288.25 / $1,737.80
| Professional | | $1,288.25 | $1,288.25 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $1,000.00 / $1,659.59
| Facility | | $741.31 | $1,000.00 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $13,182.57 / $23,988.33
| Facility | | $2,344.23 | $13,182.57 | $23,988.33 |