- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,149.52 / $6,827.70 / $18,422.72
| Facility | | $2,149.52 | $6,827.70 | $18,422.72 |
- 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
- $1,783.86 / $2,140.63 / $2,640.11
| Professional | | $1,783.86 | $2,140.63 | $2,640.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,689.01 / $2,401.48 / $3,511.54
| Facility | | $1,689.01 | $2,401.48 | $3,511.54 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $317.41 / $376.82 / $531.54
| Facility | AS | $317.41 | $376.82 | $531.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,875.32 / $2,424.39 / $8,031.00
| Facility | | $1,875.32 | $2,424.39 | $8,031.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,693.00 / $11,671.00 / $21,639.00
| Facility | | $6,693.00 | $11,671.00 | $21,639.00 |