- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $4,897.79 / $9,120.11
| Facility | | $977.24 | $4,897.79 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $1,778.28 / $1,819.70
| Facility | | $1,778.28 | $1,778.28 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $602.56 / $602.56
| Facility | | $602.56 | $602.56 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,230.27 / $1,698.24
| Professional | | $1,230.27 | $1,230.27 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $851.14 / $1,380.38
| Facility | | $724.44 | $851.14 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $6,918.31 / $10,471.29
| Facility | | $2,137.96 | $6,918.31 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $6,760.83 / $6,760.83
| Facility | | $56.23 | $6,760.83 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $676.08 / $676.08 / $676.08
| Facility | AS | $676.08 | $676.08 | $676.08 |