- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $8,709.64 / $15,135.61
| Facility | | $1,318.26 | $8,709.64 | $15,135.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $602.56 / $602.56
| Facility | | $602.56 | $602.56 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,137.96 / $3,090.30
| Professional | | $2,137.96 | $2,137.96 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,737.80 / $2,691.53
| Facility | | $1,318.26 | $1,737.80 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,168.69 / $12,302.69 / $19,054.61
| Facility | | $4,168.69 | $12,302.69 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $10,715.19 / $10,715.19
| Facility | | $56.23 | $10,715.19 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,071.52 / $1,071.52 / $1,071.52
| Facility | AS | $1,071.52 | $1,071.52 | $1,071.52 |