- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $8,912.51 / $16,595.87
| Facility | | $954.99 | $8,912.51 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $5,128.61 / $9,549.93
| Facility | | $2,041.74 | $5,128.61 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,949.84 / $2,344.23
| Facility | | $1,258.93 | $1,949.84 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $125.89 / $125.89 / $125.89
| Facility | AS | $125.89 | $125.89 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,230.27 / $1,698.24
| Professional | | $1,230.27 | $1,230.27 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $954.99 / $1,621.81
| Facility | | $724.44 | $954.99 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $11,220.18 / $16,982.44
| Facility | | $1,995.26 | $11,220.18 | $16,982.44 |