- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $4,168.69 / $8,317.64
| Facility | | $575.44 | $4,168.69 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,128.61 / $8,317.64 / $14,791.08
| Facility | | $5,128.61 | $8,317.64 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $1,778.28 / $3,019.95
| Facility | | $1,513.56 | $1,778.28 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $1,202.26 / $8,317.64
| Facility | | $588.84 | $1,202.26 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $1,258.93 / $14,125.38
| Facility | | $602.56 | $1,258.93 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $1,318.26 / $1,995.26
| Professional | | $870.96 | $1,318.26 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $6,025.60 / $8,912.51
| Facility | | $3,235.94 | $6,025.60 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $602.56 / $602.56 / $891.25
| Facility | AS | $602.56 | $602.56 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,709.64 / $13,489.63 / $17,378.01
| Facility | | $8,709.64 | $13,489.63 | $17,378.01 |