- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $7,244.36 / $21,379.62
| Facility | | $2,398.83 | $7,244.36 | $21,379.62 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,737.80 / $1,737.80 / $1,737.80
| Facility | AS | $1,737.80 | $1,737.80 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,317.64 / $13,182.57 / $28,183.83
| Facility | | $8,317.64 | $13,182.57 | $28,183.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $794.33 / $2,137.96
| Facility | | $794.33 | $794.33 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,584.89 / $2,290.87 / $6,309.57
| Professional | | $1,584.89 | $2,290.87 | $6,309.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,709.64 / $13,803.84 / $20,417.38
| Facility | | $8,709.64 | $13,803.84 | $20,417.38 |