- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,265.80 / $9,772.37 / $43,651.58
| Facility | | $4,265.80 | $9,772.37 | $43,651.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $7,585.78 / $14,454.40
| Facility | | $2,238.72 | $7,585.78 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,288.25 / $7,244.36
| Facility | | $1,258.93 | $1,288.25 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $128.82 / $128.82 / $128.82
| Facility | AS | $128.82 | $128.82 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,202.26 / $1,819.70
| Professional | | $1,202.26 | $1,202.26 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $1,047.13 / $1,819.70
| Facility | | $758.58 | $1,047.13 | $1,819.70 |
- 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 |