- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $9,120.11 / $16,595.87
| Facility | | $2,137.96 | $9,120.11 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,265.80 / $10,471.29 / $19,054.61
| Facility | | $4,265.80 | $10,471.29 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $891.25 / $7,762.47
| Facility | | $575.44 | $891.25 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $138.04 / $138.04 / $138.04
| Facility | AS | $138.04 | $138.04 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,737.80 / $1,737.80 / $1,862.09
| Professional | | $1,737.80 | $1,737.80 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $1,202.26 / $1,949.84
| Facility | | $794.33 | $1,202.26 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $17,378.01 / $26,302.68
| Facility | | $3,630.78 | $17,378.01 | $26,302.68 |