- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,754.40 / $8,511.38 / $18,197.01
| Facility | | $5,754.40 | $8,511.38 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,943.28 / $10,232.93 / $19,952.62
| Facility | | $7,943.28 | $10,232.93 | $19,952.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $5,495.41 / $5,495.41
| Facility | | $5,495.41 | $5,495.41 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $1,230.27 / $8,912.51
| Facility | | $676.08 | $1,230.27 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $190.55 / $1,905.46 / $1,905.46
| Facility | AS | $190.55 | $1,905.46 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,412.54 / $1,698.24 / $2,290.87
| Professional | | $1,412.54 | $1,698.24 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $5,495.41 / $5,495.41
| Facility | | $5,495.41 | $5,495.41 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,309.57 / $7,413.10 / $9,549.93
| Facility | | $6,309.57 | $7,413.10 | $9,549.93 |