- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $8,317.64 / $15,848.93
| Facility | | $1,778.28 | $8,317.64 | $15,848.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,481.54 / $15,488.17 / $26,302.68
| Facility | | $11,481.54 | $15,488.17 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $2,951.21 / $5,011.87
| Facility | | $2,570.40 | $2,951.21 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $2,041.74 / $8,709.64
| Facility | | $977.24 | $2,041.74 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $2,398.83 / $16,595.87
| Facility | | $977.24 | $2,398.83 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.44 / $2,187.76 / $3,311.31
| Professional | | $1,445.44 | $2,187.76 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,244.36 / $13,489.63 / $19,952.62
| Facility | | $7,244.36 | $13,489.63 | $19,952.62 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,348.96 / $1,348.96 / $1,995.26
| Facility | AS | $1,348.96 | $1,348.96 | $1,995.26 |
- 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 |