- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,168.69 / $7,943.28 / $14,454.40
| Facility | | $4,168.69 | $7,943.28 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,748.98 / $15,488.17 / $30,199.52
| Facility | | $11,748.98 | $15,488.17 | $30,199.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $3,467.37 / $13,803.84
| Facility | | $1,995.26 | $3,467.37 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $562.34 / $1,047.13 / $1,047.13
| Facility | AS | $562.34 | $1,047.13 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,168.69 / $5,011.87 / $7,079.46
| Professional | | $4,168.69 | $5,011.87 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $4,570.88 / $13,803.84
| Facility | | $3,235.94 | $4,570.88 | $13,803.84 |