- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $9,332.54 / $16,595.87
| Facility | | $1,995.26 | $9,332.54 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $9,772.37 / $19,952.62
| Facility | | $3,162.28 | $9,772.37 | $19,952.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $1,096.48 / $16,218.10
| Facility | | $707.95 | $1,096.48 | $16,218.10 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $123.03 / $123.03 / $123.03
| Facility | AS | $123.03 | $123.03 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,348.96 / $1,698.24
| Professional | | $1,348.96 | $1,348.96 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $1,071.52 / $1,819.70
| Facility | | $707.95 | $1,071.52 | $1,819.70 |
- 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 |