- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,244.36 / $8,511.38 / $16,218.10
| Facility | | $7,244.36 | $8,511.38 | $16,218.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,128.31 / $10,232.93 / $20,892.96
| Facility | | $8,128.31 | $10,232.93 | $20,892.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,128.31 / $8,128.31 / $8,128.31
| Facility | | $8,128.31 | $8,128.31 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $1,584.89 / $8,128.31
| Facility | | $912.01 | $1,584.89 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $181.97 / $467.74 / $467.74
| Facility | AS | $181.97 | $467.74 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $1,548.82 / $2,398.83
| Professional | | $1,479.11 | $1,548.82 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,128.31 / $8,128.31 / $8,128.31
| Facility | | $8,128.31 | $8,128.31 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,079.46 / $8,511.38 / $10,964.78
| Facility | | $7,079.46 | $8,511.38 | $10,964.78 |