- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $7,943.28 / $63,095.73
| Facility | | $1,380.38 | $7,943.28 | $63,095.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,548.82 / $4,265.80
| Professional | | $1,174.90 | $1,548.82 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $13,489.63 / $41,686.94
| Facility | | $3,162.28 | $13,489.63 | $41,686.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $1,659.59 / $3,311.31
| Professional | | $870.96 | $1,659.59 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $35,481.34 / $57,543.99
| Facility | | $2,691.53 | $35,481.34 | $57,543.99 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $234.42 / $234.42 / $234.42
| Facility | AS | $234.42 | $234.42 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $2,041.74 / $4,570.88
| Professional | | $977.24 | $2,041.74 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $8,511.38 / $18,197.01
| Facility | | $2,884.03 | $8,511.38 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,621.81 / $3,235.94
| Professional | | $933.25 | $1,621.81 | $3,235.94 |