- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $9,120.11 / $27,542.29
| Facility | | $1,819.70 | $9,120.11 | $27,542.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $2,187.76 / $2,951.21
| Facility | | $1,819.70 | $2,187.76 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $14,791.08 / $15,488.17
| Facility | | $2,344.23 | $14,791.08 | $15,488.17 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $269.15 / $269.15 / $269.15
| Facility | AS | $269.15 | $269.15 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,570.40 / $2,570.40 / $3,630.78
| Professional | | $2,570.40 | $2,570.40 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $2,089.30 / $3,467.37
| Facility | | $1,513.56 | $2,089.30 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $21,877.62 / $33,113.11
| Facility | | $6,606.93 | $21,877.62 | $33,113.11 |