- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $13,182.57 / $26,915.35
| Facility | | $1,318.26 | $13,182.57 | $26,915.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,022.64 / $16,982.44 / $29,512.09
| Facility | | $12,022.64 | $16,982.44 | $29,512.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $2,238.72 / $3,548.13
| Facility | | $1,905.46 | $2,238.72 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $1,479.11 / $6,456.54
| Facility | | $724.44 | $1,479.11 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $1,513.56 / $15,135.61
| Facility | | $724.44 | $1,513.56 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,621.81 / $2,454.71
| Professional | | $1,071.52 | $1,621.81 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $38,018.94 / $56,234.13 / $56,234.13
| Facility | | $38,018.94 | $56,234.13 | $56,234.13 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $3,801.89 / $3,801.89 / $5,623.41
| Facility | AS | $3,801.89 | $3,801.89 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $13,803.84 / $17,782.79
| Facility | | $8,912.51 | $13,803.84 | $17,782.79 |