- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $3,981.07 / $8,317.64
| Facility | | $912.01 | $3,981.07 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $602.56 / $602.56
| Facility | | $602.56 | $602.56 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,047.13 / $1,548.82
| Professional | | $1,047.13 | $1,047.13 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $870.96 / $1,380.38
| Facility | | $645.65 | $870.96 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,168.69 / $4,168.69 / $8,511.38
| Facility | | $4,168.69 | $4,168.69 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $9,332.54 / $14,454.40
| Facility | | $2,454.71 | $9,332.54 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $8,912.51 / $45,708.82
| Facility | | $8,912.51 | $8,912.51 | $45,708.82 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $891.25 / $891.25 / $891.25
| Facility | AS | $891.25 | $891.25 | $891.25 |