- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $1,202.26 / $8,709.64
| Facility | | $691.83 | $1,202.26 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,754.40 / $5,754.40 / $8,317.64
| Facility | | $5,754.40 | $5,754.40 | $8,317.64 |
- 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
- $1,698.24 / $1,698.24 / $1,698.24
| Professional | | $1,698.24 | $1,698.24 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $691.83 / $1,148.15
| Facility | | $478.63 | $691.83 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $14,791.08 / $22,908.68
| Facility | | $5,370.32 | $14,791.08 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $27,542.29 / $27,542.29
| Facility | | $56.23 | $27,542.29 | $27,542.29 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $2,754.23 / $2,754.23 / $2,754.23
| Facility | AS | $2,754.23 | $2,754.23 | $2,754.23 |