- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $8,912.51 / $16,595.87
| Facility | | $2,344.23 | $8,912.51 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,079.46 / $18,620.87 / $36,307.81
| Facility | | $7,079.46 | $18,620.87 | $36,307.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $1,258.93 / $14,125.38
| Facility | | $812.83 | $1,258.93 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $147.91 / $147.91 / $147.91
| Facility | AS | $147.91 | $147.91 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $1,380.38 / $1,995.26
| Professional | | $1,380.38 | $1,380.38 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $1,148.15 / $1,905.46
| Facility | | $851.14 | $1,148.15 | $1,905.46 |
- 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 |