- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $6,025.60 / $9,549.93
| Facility | | $1,659.59 | $6,025.60 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $3,890.45 / $11,220.18
| Facility | | $1,698.24 | $3,890.45 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,348.96 / $6,165.95
| Facility | | $1,348.96 | $1,348.96 | $6,165.95 |
- 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 / $1,148.15 / $4,365.16
| Professional | | $831.76 | $1,148.15 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $31.62 / $31.62 / $31.62
| Professional | AS | $31.62 | $31.62 | $31.62 |
- 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 |