- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $8,317.64 / $25,118.86
| Facility | | $851.14 | $8,317.64 | $25,118.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,022.64 / $16,982.44 / $29,512.09
| Facility | | $12,022.64 | $16,982.44 | $29,512.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $2,691.53 / $4,466.84
| Facility | | $2,290.87 | $2,691.53 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $1,778.28 / $6,456.54
| Facility | | $870.96 | $1,778.28 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $1,819.70 / $15,135.61
| Facility | | $891.25 | $1,819.70 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,949.84 / $3,019.95
| Professional | | $1,288.25 | $1,949.84 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,782.79 / $33,113.11 / $48,977.88
| Facility | | $17,782.79 | $33,113.11 | $48,977.88 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $3,311.31 / $3,311.31 / $4,897.79
| Facility | AS | $3,311.31 | $3,311.31 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $13,803.84 / $17,782.79
| Facility | | $8,912.51 | $13,803.84 | $17,782.79 |