- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $6,165.95 / $10,964.78
| Facility | | $3,467.37 | $6,165.95 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $6,606.93 / $15,135.61
| Facility | | $2,187.76 | $6,606.93 | $15,135.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $2,754.23 / $19,054.61
| Facility | | $2,511.89 | $2,754.23 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $275.42 / $275.42 / $275.42
| Facility | AS | $275.42 | $275.42 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,737.80 / $2,511.89 / $11,748.98
| Professional | | $1,737.80 | $2,511.89 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $64.57 / $64.57 / $64.57
| Professional | AS | $64.57 | $64.57 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $7,943.28 / $18,620.87
| Facility | | $2,454.71 | $7,943.28 | $18,620.87 |