- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,760.83 / $10,471.29 / $34,673.69
| Facility | | $6,760.83 | $10,471.29 | $34,673.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,168.69 / $14,125.38 / $26,302.68
| Facility | | $4,168.69 | $14,125.38 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $891.25 / $7,413.10
| Facility | | $575.44 | $891.25 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $165.96 / $165.96 / $165.96
| Facility | AS | $165.96 | $165.96 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,698.24 / $1,698.24 / $2,290.87
| Professional | | $1,698.24 | $1,698.24 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $1,348.96 / $2,238.72
| Facility | | $977.24 | $1,348.96 | $2,238.72 |
- 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 |