- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $7,943.28 / $14,454.40
| Facility | | $1,778.28 | $7,943.28 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,120.11 / $12,022.64 / $23,442.29
| Facility | | $9,120.11 | $12,022.64 | $23,442.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $1,905.46 / $15,488.17
| Facility | | $912.01 | $1,905.46 | $15,488.17 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $426.58 / $426.58 / $426.58
| Facility | AS | $426.58 | $426.58 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,089.30 / $2,137.96 / $2,951.21
| Professional | | $2,089.30 | $2,137.96 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $9,772.37 / $13,803.84
| Facility | | $6,606.93 | $9,772.37 | $13,803.84 |