- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $7,244.36 / $16,595.87
| Facility | | $2,691.53 | $7,244.36 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $7,585.78 / $14,454.40
| Facility | | $3,388.44 | $7,585.78 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $776.25 / $1,698.24
| Facility | | $501.19 | $776.25 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $169.82 / $169.82 / $169.82
| Facility | AS | $169.82 | $169.82 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,584.89 / $1,584.89 / $2,344.23
| Professional | | $1,584.89 | $1,584.89 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $1,288.25 / $2,238.72
| Facility | | $954.99 | $1,288.25 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $17,378.01 / $26,302.68
| Facility | | $3,630.78 | $17,378.01 | $26,302.68 |