- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $9,120.11 / $18,197.01
| Facility | | $1,412.54 | $9,120.11 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $5,128.61 / $9,120.11
| Facility | | $1,995.26 | $5,128.61 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $1,096.48 / $2,570.40
| Facility | | $912.01 | $1,096.48 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $91.20 / $91.20 / $91.20
| Facility | AS | $91.20 | $91.20 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $776.25 / $1,230.27
| Professional | | $776.25 | $776.25 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $676.08 / $1,230.27
| Facility | | $512.86 | $676.08 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $11,220.18 / $16,982.44
| Facility | | $1,995.26 | $11,220.18 | $16,982.44 |