- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $5,623.41 / $13,803.84
| Facility | | $1,659.59 | $5,623.41 | $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
- $2,398.83 / $2,398.83 / $3,467.37
| Professional | | $2,398.83 | $2,398.83 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $1,949.84 / $3,019.95
| Facility | | $1,479.11 | $1,949.84 | $3,019.95 |
- 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 / $19,054.61 / $19,054.61
| Facility | | $56.23 | $19,054.61 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,905.46 / $1,905.46 / $1,905.46
| Facility | AS | $1,905.46 | $1,905.46 | $1,905.46 |