- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $3,090.30 / $8,317.64
| Facility | | $1,096.48 | $3,090.30 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,197.01 / $18,197.01 / $18,197.01
| Facility | | $18,197.01 | $18,197.01 | $18,197.01 |
- 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
- $1,318.26 / $1,318.26 / $2,570.40
| Professional | | $1,318.26 | $1,318.26 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $1,258.93 / $1,949.84
| Facility | | $602.56 | $1,258.93 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $10,232.93 / $14,454.40
| Facility | | $3,311.31 | $10,232.93 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $45,708.82 / $47,863.01 / $47,863.01
| Facility | | $45,708.82 | $47,863.01 | $47,863.01 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $4,786.30 / $4,786.30 / $4,786.30
| Facility | AS | $4,786.30 | $4,786.30 | $4,786.30 |