- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $7,943.28 / $14,454.40
| Facility | | $3,548.13 | $7,943.28 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,220.18 / $14,791.08 / $28,840.32
| Facility | | $11,220.18 | $14,791.08 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $2,818.38 / $4,570.88
| Facility | | $1,737.80 | $2,818.38 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $891.25 / $891.25 / $891.25
| Facility | AS | $891.25 | $891.25 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,630.78 / $4,365.16 / $6,025.60
| Professional | | $3,630.78 | $4,365.16 | $6,025.60 |
- 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 |