- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,456.54 / $8,709.64 / $16,595.87
| Facility | | $6,456.54 | $8,709.64 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,754.40 / $14,125.38 / $26,302.68
| Facility | | $5,754.40 | $14,125.38 | $26,302.68 |
- 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
- $154.88 / $154.88 / $154.88
| Facility | AS | $154.88 | $154.88 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $1,380.38 / $2,089.30
| Professional | | $1,380.38 | $1,380.38 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $1,202.26 / $1,995.26
| Facility | | $891.25 | $1,202.26 | $1,995.26 |
- 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 |