- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $5,888.44 / $13,803.84
| Facility | | $1,659.59 | $5,888.44 | $13,803.84 |
- 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
- $2,570.40 / $2,570.40 / $3,630.78
| Professional | | $2,570.40 | $2,570.40 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $2,041.74 / $3,162.28
| Facility | | $1,548.82 | $2,041.74 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,332.54 / $21,379.62 / $28,840.32
| Facility | | $9,332.54 | $21,379.62 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $25,118.86 / $25,118.86
| Facility | | $56.23 | $25,118.86 | $25,118.86 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $2,511.89 / $2,511.89 / $2,511.89
| Facility | AS | $2,511.89 | $2,511.89 | $2,511.89 |