- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $13,803.84 / $13,803.84
| Facility | | $831.76 | $13,803.84 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $7,943.28 / $12,589.25
| Facility | | $5,011.87 | $7,943.28 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $2,570.40 / $4,168.69
| Facility | | $2,238.72 | $2,570.40 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $1,659.59 / $9,772.37
| Facility | | $851.14 | $1,659.59 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $1,737.80 / $11,220.18
| Facility | | $851.14 | $1,737.80 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,905.46 / $2,884.03
| Professional | | $1,258.93 | $1,905.46 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,168.69 / $7,762.47 / $11,481.54
| Facility | | $4,168.69 | $7,762.47 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $776.25 / $776.25 / $1,148.15
| Facility | AS | $776.25 | $776.25 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $10,232.93 / $12,589.25
| Facility | | $6,606.93 | $10,232.93 | $12,589.25 |