- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $7,943.28 / $15,135.61
| Facility | | $4,570.88 | $7,943.28 | $15,135.61 |
- 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
- $13,182.57 / $13,182.57 / $13,182.57
| Facility | | $13,182.57 | $13,182.57 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $2,344.23 / $8,709.64
| Facility | | $1,348.96 | $2,344.23 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $371.54 / $676.08 / $676.08
| Facility | AS | $371.54 | $676.08 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,818.38 / $3,235.94 / $4,570.88
| Professional | | $2,818.38 | $3,235.94 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,182.57 / $13,182.57 / $13,182.57
| Facility | | $13,182.57 | $13,182.57 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,079.46 / $8,511.38 / $19,498.45
| Facility | | $7,079.46 | $8,511.38 | $19,498.45 |