- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,760.83 / $9,120.11 / $19,498.45
| Facility | | $6,760.83 | $9,120.11 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $6,456.54 / $12,022.64
| Facility | | $2,754.23 | $6,456.54 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $851.14 / $2,570.40
| Facility | | $575.44 | $851.14 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $85.11 / $85.11 / $85.11
| Facility | AS | $85.11 | $85.11 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $831.76 / $1,148.15
| Professional | | $831.76 | $831.76 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $660.69 / $1,174.90
| Facility | | $478.63 | $660.69 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $13,182.57 / $23,442.29
| Facility | | $2,344.23 | $13,182.57 | $23,442.29 |