- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $5,370.32 / $8,317.64
| Facility | | $1,288.25 | $5,370.32 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $3,890.45 / $11,220.18
| Facility | | $1,513.56 | $3,890.45 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,096.48 / $1,202.26
| Facility | | $1,096.48 | $1,096.48 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $109.65 / $109.65 / $109.65
| Facility | AS | $109.65 | $109.65 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $933.25 / $3,630.78
| Professional | | $691.83 | $933.25 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $25.70 / $25.70 / $25.70
| Professional | AS | $25.70 | $25.70 | $25.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $6,456.54 / $12,022.64
| Facility | | $1,737.80 | $6,456.54 | $12,022.64 |