- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $8,912.51 / $13,182.57
| Facility | | $2,187.76 | $8,912.51 | $13,182.57 |
- 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
- $3,715.35 / $3,715.35 / $4,897.79
| Professional | | $3,715.35 | $3,715.35 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $2,818.38 / $4,265.80
| Facility | | $2,041.74 | $2,818.38 | $4,265.80 |
- 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 / $33,113.11 / $33,113.11
| Facility | | $56.23 | $33,113.11 | $33,113.11 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $3,311.31 / $3,311.31 / $3,311.31
| Facility | AS | $3,311.31 | $3,311.31 | $3,311.31 |