- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,002.70 / $4,771.00 / $9,539.00
| Facility | | $1,002.70 | $4,771.00 | $9,539.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,162.00 / $17,132.29 / $23,861.81
| Facility | | $11,162.00 | $17,132.29 | $23,861.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $836.93 / $1,004.32 / $1,238.66
| Professional | | $836.93 | $1,004.32 | $1,238.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $968.45 / $1,213.88 / $1,738.10
| Facility | | $968.45 | $1,213.88 | $1,738.10 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $160.81 / $194.14 / $246.96
| Facility | AS | $160.81 | $194.14 | $246.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $879.40 / $1,174.18 / $2,224.00
| Facility | | $879.40 | $1,174.18 | $2,224.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,547.00 / $3,130.00 / $5,226.00
| Facility | | $1,547.00 | $3,130.00 | $5,226.00 |