- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $5,128.61 / $13,182.57
| Facility | | $1,621.81 | $5,128.61 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $2,951.21 / $5,754.40
| Facility | | $1,023.29 | $2,951.21 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $1,047.13 / $1,862.09
| Facility | | $371.54 | $1,047.13 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $104.71 / $104.71 / $104.71
| Facility | AS | $104.71 | $104.71 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $870.96 / $977.24
| Professional | | $870.96 | $870.96 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $851.14 / $1,318.26
| Facility | | $602.56 | $851.14 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $10,232.93 / $16,982.44
| Facility | | $933.25 | $10,232.93 | $16,982.44 |