- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $6,606.93 / $11,481.54
| Facility | | $1,737.80 | $6,606.93 | $11,481.54 |
- 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
- $2,951.21 / $2,951.21 / $4,168.69
| Professional | | $2,951.21 | $2,951.21 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $2,290.87 / $3,548.13
| Facility | | $1,737.80 | $2,290.87 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $15,135.61 / $22,908.68
| Facility | | $5,370.32 | $15,135.61 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $22,387.21 / $22,387.21
| Facility | | $56.23 | $22,387.21 | $22,387.21 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $2,238.72 / $2,238.72 / $2,238.72
| Facility | AS | $2,238.72 | $2,238.72 | $2,238.72 |