- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $9,120.11 / $16,595.87
| Facility | | $2,570.40 | $9,120.11 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,265.80 / $10,000.00 / $19,054.61
| Facility | | $4,265.80 | $10,000.00 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $891.25 / $5,754.40
| Facility | | $575.44 | $891.25 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $165.96 / $165.96 / $165.96
| Facility | AS | $165.96 | $165.96 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,659.59 / $1,659.59 / $2,238.72
| Professional | | $1,659.59 | $1,659.59 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $1,318.26 / $2,137.96
| Facility | | $954.99 | $1,318.26 | $2,137.96 |
- 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 |