- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $10,715.19 / $16,595.87
| Facility | | $3,235.94 | $10,715.19 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $8,317.64 / $14,125.38
| Facility | | $5,011.87 | $8,317.64 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $2,041.74 / $3,388.44
| Facility | | $1,737.80 | $2,041.74 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $1,318.26 / $5,495.41
| Facility | | $660.69 | $1,318.26 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $1,412.54 / $15,135.61
| Facility | | $660.69 | $1,412.54 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $1,479.11 / $2,290.87
| Professional | | $977.24 | $1,479.11 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,244.36 / $13,489.63 / $19,952.62
| Facility | | $7,244.36 | $13,489.63 | $19,952.62 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,348.96 / $1,348.96 / $1,995.26
| Facility | AS | $1,348.96 | $1,348.96 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,585.78 / $12,302.69 / $16,595.87
| Facility | | $7,585.78 | $12,302.69 | $16,595.87 |