- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $2,818.38 / $12,302.69
| Facility | | $851.14 | $2,818.38 | $12,302.69 |
- 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
- $1,230.27 / $1,230.27 / $2,041.74
| Professional | | $1,230.27 | $1,230.27 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $1,023.29 / $1,621.81
| Facility | | $831.76 | $1,023.29 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,025.60 / $14,791.08 / $22,908.68
| Facility | | $6,025.60 | $14,791.08 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,952.62 / $72,443.60 / $72,443.60
| Facility | | $19,952.62 | $72,443.60 | $72,443.60 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $7,244.36 / $7,244.36 / $7,244.36
| Facility | AS | $7,244.36 | $7,244.36 | $7,244.36 |