- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $5,495.41 / $9,549.93
| Facility | | $1,737.80 | $5,495.41 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $4,265.80 / $12,022.64
| Facility | | $1,698.24 | $4,265.80 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,348.96 / $1,479.11
| Facility | | $1,348.96 | $1,348.96 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $147.91 / $147.91 / $147.91
| Facility | AS | $147.91 | $147.91 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,258.93 / $4,786.30
| Professional | | $891.25 | $1,258.93 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $34.67 / $34.67 / $34.67
| Professional | AS | $34.67 | $34.67 | $34.67 |
- 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 |