- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $4,365.16 / $11,481.54
| Facility | | $851.14 | $4,365.16 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $831.76 / $2,187.76
| Professional | | $489.78 | $831.76 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $7,079.46 / $14,454.40
| Facility | | $2,818.38 | $7,079.46 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $794.33 / $1,412.54
| Professional | | $446.68 | $794.33 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $1,862.09 / $7,943.28
| Facility | | $794.33 | $1,862.09 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $89.13 / $89.13 / $89.13
| Facility | AS | $89.13 | $89.13 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $977.24 / $2,137.96
| Professional | | $562.34 | $977.24 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $5,623.41 / $12,302.69
| Facility | | $1,995.26 | $5,623.41 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $794.33 / $1,584.89
| Professional | | $478.63 | $794.33 | $1,584.89 |