- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,168.69 / $10,471.29 / $18,197.01
| Facility | | $4,168.69 | $10,471.29 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $23,442.29 / $44,668.36
| Facility | | $4,365.16 | $23,442.29 | $44,668.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $891.25 / $2,754.23
| Facility | | $891.25 | $891.25 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $269.15 / $269.15 / $269.15
| Facility | AS | $269.15 | $269.15 | $269.15 |
- 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 / $2,089.30 / $3,467.37
| Facility | | $1,548.82 | $2,089.30 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,317.64 / $23,442.29 / $41,686.94
| Facility | | $8,317.64 | $23,442.29 | $41,686.94 |