- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $2,754.23 / $11,220.18
| Facility | | $1,737.80 | $2,754.23 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $602.56 / $15,488.17
| Facility | | $602.56 | $602.56 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,884.03 / $2,884.03 / $4,168.69
| Professional | | $2,884.03 | $2,884.03 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $2,290.87 / $3,548.13
| Facility | | $1,737.80 | $2,290.87 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $3,890.45 / $6,918.31
| Facility | | $1,047.13 | $3,890.45 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $22,387.21 / $22,387.21
| Facility | | $5,011.87 | $22,387.21 | $22,387.21 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $2,238.72 / $2,238.72 / $2,238.72
| Facility | AS | $2,238.72 | $2,238.72 | $2,238.72 |