- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,001.21 / $5,048.00 / $14,187.00
| Facility | | $1,001.21 | $5,048.00 | $14,187.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,385.00 / $9,527.62 / $13,270.04
| Facility | | $6,385.00 | $9,527.62 | $13,270.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $849.48 / $1,019.38 / $1,258.74
| Professional | | $849.48 | $1,019.38 | $1,258.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $942.30 / $1,175.07 / $1,692.04
| Facility | | $942.30 | $1,175.07 | $1,692.04 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $147.47 / $219.98 / $241.02
| Facility | AS | $147.47 | $219.98 | $241.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $885.15 / $1,160.46 / $2,225.60
| Facility | | $885.15 | $1,160.46 | $2,225.60 |
- 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 |