- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $11,481.54 / $40,738.03
| Facility | | $3,981.07 | $11,481.54 | $40,738.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $18,197.01 / $34,673.69
| Facility | | $4,365.16 | $18,197.01 | $34,673.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $891.25 / $2,630.27
| Facility | | $575.44 | $891.25 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $263.03 / $263.03 / $263.03
| Facility | AS | $263.03 | $263.03 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,344.23 / $2,344.23 / $3,548.13
| Professional | | $2,344.23 | $2,344.23 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $1,905.46 / $3,311.31
| Facility | | $1,479.11 | $1,905.46 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $20,417.38 / $25,703.96
| Facility | | $4,677.35 | $20,417.38 | $25,703.96 |