- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $3,715.35 / $7,413.10
| Facility | | $1,122.02 | $3,715.35 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $2,630.27 / $6,025.60
| Facility | | $794.33 | $2,630.27 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $1,230.27 / $2,187.76
| Facility | | $645.65 | $1,230.27 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $123.03 / $123.03 / $123.03
| Facility | AS | $123.03 | $123.03 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $1,071.52 / $4,168.69
| Professional | | $812.83 | $1,071.52 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $28.84 / $28.84 / $28.84
| Professional | AS | $28.84 | $28.84 | $28.84 |
- 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 |