- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $7,943.28 / $28,840.32
| Facility | | $2,630.27 | $7,943.28 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $8,511.38 / $15,848.93
| Facility | | $4,570.88 | $8,511.38 | $15,848.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $66.07 / $4,677.35 / $15,135.61
| Facility | | $66.07 | $4,677.35 | $15,135.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,332.54 / $9,332.54 / $9,332.54
| Facility | | $9,332.54 | $9,332.54 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $851.14 / $6,606.93
| Professional | | $776.25 | $851.14 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $831.76 / $1,698.24
| Professional | | $630.96 | $831.76 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,915.35 / $26,915.35 / $45,708.82
| Facility | | $26,915.35 | $26,915.35 | $45,708.82 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $2,691.53 / $2,691.53 / $2,691.53
| Facility | AS | $2,691.53 | $2,691.53 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $933.25 / $1,659.59
| Facility | | $691.83 | $933.25 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,943.28 / $14,454.40 / $37,153.52
| Facility | | $7,943.28 | $14,454.40 | $37,153.52 |