- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $9,120.11 / $16,595.87
| Facility | | $1,949.84 | $9,120.11 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $9,332.54 / $17,782.79
| Facility | | $2,238.72 | $9,332.54 | $17,782.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $891.25 / $1,230.27
| Facility | | $891.25 | $891.25 | $1,230.27 |
- 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
- $1,230.27 / $1,230.27 / $1,659.59
| Professional | | $1,230.27 | $1,230.27 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $954.99 / $1,584.89
| Facility | | $691.83 | $954.99 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $19,952.62 / $25,703.96
| Facility | | $4,677.35 | $19,952.62 | $25,703.96 |