- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $7,943.28 / $16,595.87
| Facility | | $1,202.26 | $7,943.28 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $5,128.61 / $9,772.37
| Facility | | $1,023.29 | $5,128.61 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $1,380.38 / $1,778.28
| Facility | | $371.54 | $1,380.38 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $138.04 / $138.04 / $138.04
| Facility | AS | $138.04 | $138.04 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,202.26 / $1,380.38
| Professional | | $1,202.26 | $1,202.26 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $1,122.02 / $1,778.28
| Facility | | $812.83 | $1,122.02 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $12,589.25 / $22,387.21
| Facility | | $1,230.27 | $12,589.25 | $22,387.21 |