- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $10,000.00 / $18,197.01
| Facility | | $3,162.28 | $10,000.00 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $10,715.19 / $19,952.62
| Facility | | $4,466.84 | $10,715.19 | $19,952.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $14,791.08 / $15,488.17
| Facility | | $2,041.74 | $14,791.08 | $15,488.17 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $204.17 / $204.17 / $204.17
| Facility | AS | $204.17 | $204.17 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,905.46 / $1,905.46 / $2,754.23
| Professional | | $1,905.46 | $1,905.46 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,584.89 / $2,630.27
| Facility | | $1,174.90 | $1,584.89 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $18,197.01 / $25,703.96
| Facility | | $4,677.35 | $18,197.01 | $25,703.96 |