- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $7,413.10 / $18,197.01
| Facility | | $1,230.27 | $7,413.10 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $4,677.35 / $20,892.96
| Facility | | $2,041.74 | $4,677.35 | $20,892.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,258.93 / $1,862.09
| Facility | | $1,258.93 | $1,258.93 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $125.89 / $125.89 / $125.89
| Facility | AS | $125.89 | $125.89 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $1,122.02 / $4,168.69
| Professional | | $794.33 | $1,122.02 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $29.51 / $29.51 / $29.51
| Professional | AS | $29.51 | $29.51 | $29.51 |
- 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 |