- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,109.58 / $5,412.00 / $15,364.02
| Facility | | $1,109.58 | $5,412.00 | $15,364.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,153.00 / $7,363.00 / $9,410.00
| Facility | | $6,153.00 | $7,363.00 | $9,410.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $885.15 / $1,062.18 / $1,310.02
| Professional | | $885.15 | $1,062.18 | $1,310.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,093.51 / $1,349.14 / $1,985.37
| Facility | | $1,093.51 | $1,349.14 | $1,985.37 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $215.50 / $236.69 / $273.75
| Facility | AS | $215.50 | $236.69 | $273.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $985.96 / $1,317.14 / $9,929.00
| Facility | | $985.96 | $1,317.14 | $9,929.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,367.00 / $13,296.00 / $26,537.00
| Facility | | $8,367.00 | $13,296.00 | $26,537.00 |