- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $5,011.87 / $11,481.54
| Facility | | $645.65 | $5,011.87 | $11,481.54 |
- 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
- $309.03 / $588.84 / $1,621.81
| Professional | | $309.03 | $588.84 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $724.44 / $14,125.38
| Facility | | $363.08 | $724.44 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,548.82 / $1,548.82 / $1,548.82
| Facility | AS | $1,548.82 | $1,548.82 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $741.31 / $891.25
| Professional | | $575.44 | $741.31 | $891.25 |
- 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 / $9,332.54 / $15,848.93
| Facility | | $4,168.69 | $9,332.54 | $15,848.93 |