- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $10,471.29 / $18,197.01
| Facility | | $3,981.07 | $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 / $2,570.40
| Facility | | $891.25 | $891.25 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $257.04 / $257.04 / $257.04
| Facility | AS | $257.04 | $257.04 | $257.04 |
- 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 / $1,995.26 / $3,311.31
| Facility | | $1,479.11 | $1,995.26 | $3,311.31 |
- 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 |