- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $8,511.38 / $15,848.93
| Facility | | $1,698.24 | $8,511.38 | $15,848.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,481.54 / $15,488.17 / $26,302.68
| Facility | | $11,481.54 | $15,488.17 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,511.89 / $4,073.80
| Facility | | $2,137.96 | $2,511.89 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $1,698.24 / $7,244.36
| Facility | | $831.76 | $1,698.24 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $1,905.46 / $16,595.87
| Facility | | $831.76 | $1,905.46 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,862.09 / $2,818.38
| Professional | | $1,230.27 | $1,862.09 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,197.01 / $18,197.01 / $26,915.35
| Facility | | $18,197.01 | $18,197.01 | $26,915.35 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,819.70 / $1,819.70 / $2,691.53
| Facility | AS | $1,819.70 | $1,819.70 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $13,803.84 / $17,782.79
| Facility | | $8,912.51 | $13,803.84 | $17,782.79 |