- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $5,370.32 / $8,317.64
| Facility | | $1,202.26 | $5,370.32 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $3,090.30 / $6,025.60
| Facility | | $1,230.27 | $3,090.30 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,202.26 / $2,187.76
| Facility | | $1,071.52 | $1,202.26 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $107.15 / $107.15 / $107.15
| Facility | AS | $107.15 | $107.15 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $954.99 / $3,467.37
| Professional | | $645.65 | $954.99 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $24.55 / $24.55 / $24.55
| Professional | AS | $24.55 | $24.55 | $24.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $5,623.41 / $8,511.38
| Facility | | $1,513.56 | $5,623.41 | $8,511.38 |