- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $61.66 / $6,456.54 / $12,589.25
| Facility | | $61.66 | $6,456.54 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $5,888.44 / $11,481.54
| Facility | | $4,570.88 | $5,888.44 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $2,454.71 / $2,454.71
| Facility | | $2,454.71 | $2,454.71 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $1,122.02 / $8,912.51
| Facility | | $707.95 | $1,122.02 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $173.78 / $851.14 / $851.14
| Facility | AS | $173.78 | $851.14 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,548.82 / $2,089.30
| Professional | | $1,318.26 | $1,548.82 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $2,454.71 / $2,454.71
| Facility | | $2,454.71 | $2,454.71 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $7,244.36 / $9,772.37
| Facility | | $4,073.80 | $7,244.36 | $9,772.37 |