- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $6,456.54 / $11,481.54
| Facility | | $1,584.89 | $6,456.54 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,413.10 / $9,549.93 / $18,620.87
| Facility | | $7,413.10 | $9,549.93 | $18,620.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $5,495.41 / $5,495.41
| Facility | | $5,495.41 | $5,495.41 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $1,348.96 / $10,471.29
| Facility | | $812.83 | $1,348.96 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $199.53 / $1,905.46 / $1,905.46
| Facility | AS | $199.53 | $1,905.46 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $1,778.28 / $2,398.83
| Professional | | $1,479.11 | $1,778.28 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $5,495.41 / $5,495.41
| Facility | | $5,495.41 | $5,495.41 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,309.57 / $7,413.10 / $10,964.78
| Facility | | $6,309.57 | $7,413.10 | $10,964.78 |