- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.87 / $2,951.21 / $8,317.64
| Facility | | $0.87 | $2,951.21 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,715.19 / $15,135.61 / $26,302.68
| Facility | | $10,715.19 | $15,135.61 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $2,290.87 / $3,630.78
| Facility | | $1,949.84 | $2,290.87 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $1,479.11 / $6,456.54
| Facility | | $741.31 | $1,479.11 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $1,548.82 / $15,135.61
| Facility | | $758.58 | $1,548.82 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,698.24 / $2,570.40
| Professional | | $1,122.02 | $1,698.24 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,489.63 / $19,952.62 / $19,952.62
| Facility | | $13,489.63 | $19,952.62 | $19,952.62 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,348.96 / $1,348.96 / $1,995.26
| Facility | AS | $1,348.96 | $1,348.96 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,585.78 / $12,302.69 / $16,595.87
| Facility | | $7,585.78 | $12,302.69 | $16,595.87 |