- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $10,471.29 / $18,197.01
| Facility | | $1,202.26 | $10,471.29 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $6,606.93 / $12,589.25
| Facility | | $2,884.03 | $6,606.93 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $758.58 / $2,570.40
| Facility | | $707.95 | $758.58 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $75.86 / $75.86 / $75.86
| Facility | AS | $75.86 | $75.86 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $776.25 / $1,047.13
| Professional | | $776.25 | $776.25 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $616.60 / $1,047.13
| Facility | | $436.52 | $616.60 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $13,182.57 / $23,442.29
| Facility | | $2,344.23 | $13,182.57 | $23,442.29 |