- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $10,471.29 / $18,197.01
| Facility | | $2,951.21 | $10,471.29 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,890.45 / $18,197.01 / $34,673.69
| Facility | | $3,890.45 | $18,197.01 | $34,673.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $891.25 / $1,905.46
| Facility | | $891.25 | $891.25 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $190.55 / $190.55 / $190.55
| Facility | AS | $190.55 | $190.55 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,905.46 / $1,905.46 / $2,570.40
| Professional | | $1,905.46 | $1,905.46 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,513.56 / $2,454.71
| Facility | | $1,096.48 | $1,513.56 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $20,417.38 / $25,703.96
| Facility | | $4,677.35 | $20,417.38 | $25,703.96 |