- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,778.28 / $8,709.64
| Facility | | $1,000.00 | $1,778.28 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $602.56 / $602.56
| Facility | | $602.56 | $602.56 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,230.27 / $1,659.59
| Professional | | $1,230.27 | $1,230.27 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $933.25 / $1,445.44
| Facility | | $707.95 | $933.25 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $15,135.61 / $22,908.68
| Facility | | $5,370.32 | $15,135.61 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $4,570.88 / $4,570.88
| Facility | | $56.23 | $4,570.88 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $457.09 / $457.09 / $457.09
| Facility | AS | $457.09 | $457.09 | $457.09 |