- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $10,000.00 / $18,197.01
| Facility | | $1,862.09 | $10,000.00 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $12,302.69 / $22,387.21
| Facility | | $5,370.32 | $12,302.69 | $22,387.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $1,230.27 / $7,585.78
| Facility | | $812.83 | $1,230.27 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $123.03 / $123.03 / $123.03
| Facility | AS | $123.03 | $123.03 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,047.13 / $1,778.28
| Professional | | $1,047.13 | $1,047.13 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $912.01 / $1,548.82
| Facility | | $724.44 | $912.01 | $1,548.82 |
- 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 |