- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $1,905.46 / $14,454.40
| Facility | | $891.25 | $1,905.46 | $14,454.40 |
- 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
- $2,398.83 / $2,818.38 / $4,466.84
| Facility | | $2,398.83 | $2,818.38 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $1,862.09 / $6,456.54
| Facility | | $912.01 | $1,862.09 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $1,905.46 / $15,135.61
| Facility | | $912.01 | $1,905.46 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.96 / $2,041.74 / $3,162.28
| Professional | | $1,348.96 | $2,041.74 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34,673.69 / $51,286.14 / $51,286.14
| Facility | | $34,673.69 | $51,286.14 | $51,286.14 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $3,467.37 / $3,467.37 / $5,128.61
| Facility | AS | $3,467.37 | $3,467.37 | $5,128.61 |
- 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 |