- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,485.86 / $5,412.00 / $16,216.00
| Facility | | $1,485.86 | $5,412.00 | $16,216.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,738.20 / $20,977.18 / $29,216.95
| Facility | | $12,738.20 | $20,977.18 | $29,216.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,225.51 / $1,470.61 / $1,813.75
| Professional | | $1,225.51 | $1,470.61 | $1,813.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.85 / $1,755.51 / $2,502.46
| Facility | | $1,350.85 | $1,755.51 | $2,502.46 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $226.33 / $322.20 / $384.39
| Facility | AS | $226.33 | $322.20 | $384.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,317.55 / $1,753.12 / $7,902.00
| Facility | | $1,317.55 | $1,753.12 | $7,902.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,408.00 / $11,872.00 / $26,537.00
| Facility | | $7,408.00 | $11,872.00 | $26,537.00 |