- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $4,786.30 / $8,317.64
| Facility | | $691.83 | $4,786.30 | $8,317.64 |
- 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
- $691.83 / $1,202.26 / $4,786.30
| Facility | | $691.83 | $1,202.26 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $69.18 / $69.18 / $69.18
| Facility | AS | $69.18 | $69.18 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $741.31 / $3,162.28
| Professional | | $436.52 | $741.31 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $16.22 / $16.22 / $23.44
| Professional | AS | $16.22 | $16.22 | $23.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $4,168.69 / $6,918.31
| Facility | | $1,122.02 | $4,168.69 | $6,918.31 |