- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $2,884.03 / $16,982.44
| Facility | | $707.95 | $2,884.03 | $16,982.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $3,090.30 / $3,162.28
| Facility | | $3,090.30 | $3,090.30 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $602.56 / $602.56
| Facility | | $602.56 | $602.56 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,288.25 / $2,137.96
| Professional | | $1,288.25 | $1,288.25 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $891.25 / $1,412.54
| Facility | | $436.52 | $891.25 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $14,791.08 / $22,908.68
| Facility | | $5,011.87 | $14,791.08 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $29,512.09 / $29,512.09
| Facility | | $56.23 | $29,512.09 | $29,512.09 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $2,951.21 / $2,951.21 / $2,951.21
| Facility | AS | $2,951.21 | $2,951.21 | $2,951.21 |