- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $9,120.11 / $16,595.87
| Facility | | $2,238.72 | $9,120.11 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $2,454.71 / $2,454.71
| Facility | | $2,454.71 | $2,454.71 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $575.44 / $1,445.44
| Facility | | $34.67 | $575.44 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $144.54 / $144.54 / $144.54
| Facility | AS | $144.54 | $144.54 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,047.13 / $1,258.93
| Professional | | $1,047.13 | $1,047.13 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $1,096.48 / $1,778.28
| Facility | | $812.83 | $1,096.48 | $1,778.28 |
- 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 |