- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $6,760.83 / $16,218.10
| Facility | | $1,548.82 | $6,760.83 | $16,218.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $3,981.07 / $20,892.96
| Facility | | $1,513.56 | $3,981.07 | $20,892.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,202.26 / $4,786.30
| Facility | | $1,148.15 | $1,202.26 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $114.82 / $114.82 / $114.82
| Facility | AS | $114.82 | $114.82 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $1,023.29 / $3,801.89
| Professional | | $724.44 | $1,023.29 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $26.92 / $26.92 / $26.92
| Professional | AS | $26.92 | $26.92 | $26.92 |
- 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 |