- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $4,786.30 / $9,332.54
| Facility | | $602.56 | $4,786.30 | $9,332.54 |
- 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
- $316.23 / $616.60 / $1,698.24
| Professional | | $316.23 | $616.60 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $758.58 / $14,125.38
| Facility | | $389.05 | $758.58 | $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
- $602.56 / $776.25 / $933.25
| Professional | | $602.56 | $776.25 | $933.25 |
- 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 |