- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $5,370.32 / $7,413.10
| Facility | | $1,949.84 | $5,370.32 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $4,265.80 / $12,022.64
| Facility | | $1,513.56 | $4,265.80 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,819.70 / $12,302.69
| Facility | | $1,202.26 | $1,819.70 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $181.97 / $181.97 / $181.97
| Facility | AS | $181.97 | $181.97 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,513.56 / $6,025.60
| Professional | | $1,148.15 | $1,513.56 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $42.66 / $42.66 / $42.66
| Professional | AS | $42.66 | $42.66 | $42.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $7,762.47 / $17,378.01
| Facility | | $1,995.26 | $7,762.47 | $17,378.01 |