- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $2,754.23 / $8,709.64
| Facility | | $1,698.24 | $2,754.23 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,760.83 / $6,760.83 / $6,918.31
| Facility | | $6,760.83 | $6,760.83 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $602.56 / $602.56
| Facility | | $602.56 | $602.56 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,884.03 / $2,884.03 / $4,073.80
| Professional | | $2,884.03 | $2,884.03 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $2,290.87 / $3,630.78
| Facility | | $1,698.24 | $2,290.87 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $15,135.61 / $22,908.68
| Facility | | $5,370.32 | $15,135.61 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,877.62 / $21,877.62 / $39,810.72
| Facility | | $21,877.62 | $21,877.62 | $39,810.72 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $2,187.76 / $2,187.76 / $2,187.76
| Facility | AS | $2,187.76 | $2,187.76 | $2,187.76 |