- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $10,471.29 / $18,197.01
| Facility | | $1,659.59 | $10,471.29 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,265.80 / $10,000.00 / $18,620.87
| Facility | | $4,265.80 | $10,000.00 | $18,620.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $1,096.48 / $7,585.78
| Facility | | $707.95 | $1,096.48 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $109.65 / $109.65 / $109.65
| Facility | AS | $109.65 | $109.65 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,047.13 / $1,479.11
| Professional | | $1,047.13 | $1,047.13 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $851.14 / $1,380.38
| Facility | | $630.96 | $851.14 | $1,380.38 |
- 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 |