- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $7,943.28 / $14,454.40
| Facility | | $1,778.28 | $7,943.28 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $6,456.54 / $12,589.25
| Facility | | $4,897.79 | $6,456.54 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $1,548.82 / $13,803.84
| Facility | | $891.25 | $1,548.82 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $416.87 / $416.87 / $416.87
| Facility | AS | $416.87 | $416.87 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,995.26 / $2,089.30 / $2,818.38
| Professional | | $1,995.26 | $2,089.30 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $4,570.88 / $13,803.84
| Facility | | $3,235.94 | $4,570.88 | $13,803.84 |