- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $10,471.29 / $18,197.01
| Facility | | $1,348.96 | $10,471.29 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $9,332.54 / $17,782.79
| Facility | | $870.96 | $9,332.54 | $17,782.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $851.14 / $891.25
| Facility | | $501.19 | $851.14 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $85.11 / $85.11 / $85.11
| Facility | AS | $85.11 | $85.11 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $870.96 / $1,174.90
| Professional | | $870.96 | $870.96 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $707.95 / $1,174.90
| Facility | | $501.19 | $707.95 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $16,982.44 / $25,703.96
| Facility | | $3,630.78 | $16,982.44 | $25,703.96 |