- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $11,220.18 / $16,595.87
| Facility | | $2,344.23 | $11,220.18 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $10,000.00 / $18,197.01
| Facility | | $3,981.07 | $10,000.00 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $2,344.23 / $7,585.78
| Facility | | $1,479.11 | $2,344.23 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $147.91 / $147.91 / $147.91
| Facility | AS | $147.91 | $147.91 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $1,479.11 / $2,041.74
| Professional | | $1,479.11 | $1,479.11 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $1,174.90 / $1,905.46
| Facility | | $851.14 | $1,174.90 | $1,905.46 |
- 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 |