- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $10,471.29 / $24,547.09
| Facility | | $575.44 | $10,471.29 | $24,547.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $6,165.95 / $12,022.64
| Facility | | $2,754.23 | $6,165.95 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $851.14 / $1,995.26
| Facility | | $707.95 | $851.14 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $85.11 / $85.11 / $85.11
| Facility | AS | $85.11 | $85.11 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $831.76 / $1,148.15
| Professional | | $831.76 | $831.76 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $676.08 / $1,230.27
| Facility | | $489.78 | $676.08 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $13,182.57 / $23,442.29
| Facility | | $2,511.89 | $13,182.57 | $23,442.29 |