- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $5,623.41 / $9,549.93
| Facility | | $1,348.96 | $5,623.41 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $3,890.45 / $11,220.18
| Facility | | $1,659.59 | $3,890.45 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,348.96 / $6,309.57
| Facility | | $1,348.96 | $1,348.96 | $6,309.57 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $134.90 / $134.90 / $134.90
| Facility | AS | $134.90 | $134.90 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,047.13 / $4,365.16
| Professional | | $831.76 | $1,047.13 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $30.90 / $30.90 / $30.90
| Professional | AS | $30.90 | $30.90 | $30.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $7,413.10 / $17,378.01
| Facility | | $1,995.26 | $7,413.10 | $17,378.01 |