- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $5,370.32 / $7,943.28
| Facility | | $1,258.93 | $5,370.32 | $7,943.28 |
- 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
- $1,202.26 / $1,380.38 / $4,786.30
| Facility | | $1,202.26 | $1,380.38 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $138.04 / $138.04 / $138.04
| Facility | AS | $138.04 | $138.04 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,230.27 / $4,677.35
| Professional | | $891.25 | $1,230.27 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $32.36 / $32.36 / $32.36
| Professional | AS | $32.36 | $32.36 | $32.36 |
- 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 |