- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,943.28 / $12,882.50 / $23,988.33
| Facility | | $7,943.28 | $12,882.50 | $23,988.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $12,302.69 / $22,387.21
| Facility | | $5,370.32 | $12,302.69 | $22,387.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $1,258.93 / $13,803.84
| Facility | | $812.83 | $1,258.93 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $144.54 / $144.54 / $144.54
| Facility | AS | $144.54 | $144.54 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $1,380.38 / $1,949.84
| Professional | | $1,380.38 | $1,380.38 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $1,122.02 / $1,949.84
| Facility | | $831.76 | $1,122.02 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $20,892.96 / $32,359.37
| Facility | | $4,677.35 | $20,892.96 | $32,359.37 |