- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $13,489.63 / $28,183.83
| Facility | | $1,479.11 | $13,489.63 | $28,183.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,022.64 / $16,982.44 / $29,512.09
| Facility | | $12,022.64 | $16,982.44 | $29,512.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $2,951.21 / $4,677.35
| Facility | | $2,511.89 | $2,951.21 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $7,079.46 / $13,489.63
| Facility | | $1,047.13 | $7,079.46 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $9,772.37 / $17,378.01
| Facility | | $1,047.13 | $9,772.37 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $2,238.72 / $3,388.44
| Professional | | $1,148.15 | $2,238.72 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,620.87 / $27,542.29 / $27,542.29
| Facility | | $18,620.87 | $27,542.29 | $27,542.29 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,862.09 / $1,862.09 / $2,754.23
| Facility | AS | $1,862.09 | $1,862.09 | $2,754.23 |
- 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 |