- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $9,549.93 / $15,135.61
| Facility | | $2,691.53 | $9,549.93 | $15,135.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,511.38 / $11,220.18 / $21,877.62
| Facility | | $8,511.38 | $11,220.18 | $21,877.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $2,951.21 / $9,772.37
| Facility | | $1,288.25 | $2,951.21 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,318.26 / $1,318.26 / $1,318.26
| Facility | AS | $1,318.26 | $1,318.26 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,884.03 / $3,019.95 / $4,073.80
| Professional | | $2,884.03 | $3,019.95 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,309.57 / $7,413.10 / $9,120.11
| Facility | | $6,309.57 | $7,413.10 | $9,120.11 |