- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $3,981.07 / $12,302.69
| Facility | | $707.95 | $3,981.07 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,244.36 / $7,244.36 / $7,244.36
| Facility | | $7,244.36 | $7,244.36 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $776.25 / $1,905.46
| Professional | | $389.05 | $776.25 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $954.99 / $14,454.40
| Facility | | $467.74 | $954.99 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,584.89 / $1,584.89 / $1,584.89
| Facility | AS | $1,584.89 | $1,584.89 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,023.29 / $1,122.02
| Professional | | $851.14 | $1,023.29 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,244.36 / $7,244.36 / $7,244.36
| Facility | | $7,244.36 | $7,244.36 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,168.69 / $9,120.11 / $15,488.17
| Facility | | $4,168.69 | $9,120.11 | $15,488.17 |