- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $11,220.18 / $36,307.81
| Facility | | $2,884.03 | $11,220.18 | $36,307.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,760.83 / $18,620.87 / $34,673.69
| Facility | | $6,760.83 | $18,620.87 | $34,673.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $1,096.48 / $14,791.08
| Facility | | $707.95 | $1,096.48 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $181.97 / $181.97 / $181.97
| Facility | AS | $181.97 | $181.97 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,698.24 / $1,698.24 / $2,511.89
| Professional | | $1,698.24 | $1,698.24 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,412.54 / $2,344.23
| Facility | | $1,047.13 | $1,412.54 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $20,417.38 / $25,703.96
| Facility | | $4,677.35 | $20,417.38 | $25,703.96 |