- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $7,943.28 / $14,454.40
| Facility | | $3,235.94 | $7,943.28 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,549.93 / $12,589.25 / $24,547.09
| Facility | | $9,549.93 | $12,589.25 | $24,547.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $2,630.27 / $4,365.16
| Facility | | $1,621.81 | $2,630.27 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $812.83 / $812.83 / $812.83
| Facility | AS | $812.83 | $812.83 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,388.44 / $4,168.69 / $5,623.41
| Professional | | $3,388.44 | $4,168.69 | $5,623.41 |
- 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 |