- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $8,709.64 / $16,595.87
| Facility | | $794.33 | $8,709.64 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $6,606.93 / $12,589.25
| Facility | | $2,884.03 | $6,606.93 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $891.25 / $7,943.28
| Facility | | $812.83 | $891.25 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $81.28 / $81.28 / $81.28
| Facility | AS | $81.28 | $81.28 | $81.28 |
- 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
- $489.78 / $741.31 / $1,230.27
| Facility | | $489.78 | $741.31 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $20,417.38 / $25,703.96
| Facility | | $3,019.95 | $20,417.38 | $25,703.96 |