- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $10,000.00 / $18,197.01
| Facility | | $5,011.87 | $10,000.00 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $9,332.54 / $17,782.79
| Facility | | $2,041.74 | $9,332.54 | $17,782.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $891.25 / $3,162.28
| Facility | | $891.25 | $891.25 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $316.23 / $316.23 / $316.23
| Facility | AS | $316.23 | $316.23 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,235.94 / $3,235.94 / $4,265.80
| Professional | | $3,235.94 | $3,235.94 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $2,570.40 / $4,168.69
| Facility | | $1,819.70 | $2,570.40 | $4,168.69 |
- 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 |