- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $995.41 / $5,087.00 / $8,920.00
| Facility | | $995.41 | $5,087.00 | $8,920.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,671.00 / $14,495.61 / $20,189.45
| Facility | | $8,671.00 | $14,495.61 | $20,189.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $855.12 / $1,026.14 / $1,265.58
| Professional | | $855.12 | $1,026.14 | $1,265.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $850.46 / $1,198.07 / $1,702.42
| Facility | | $850.46 | $1,198.07 | $1,702.42 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $160.53 / $220.51 / $250.45
| Facility | AS | $160.53 | $220.51 | $250.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $901.30 / $1,183.63 / $2,224.00
| Facility | | $901.30 | $1,183.63 | $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 |