- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $7,943.28 / $16,595.87
| Facility | | $1,288.25 | $7,943.28 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $562.34 / $1,819.70
| Facility | | $34.67 | $562.34 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $181.97 / $181.97 / $181.97
| Facility | AS | $181.97 | $181.97 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $1,380.38 / $1,621.81
| Professional | | $1,380.38 | $1,380.38 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,445.44 / $2,238.72
| Facility | | $1,071.52 | $1,445.44 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $6,165.95 / $8,912.51
| Facility | | $478.63 | $6,165.95 | $8,912.51 |