- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $7,943.28 / $13,182.57
| Facility | | $1,258.93 | $7,943.28 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $5,370.32 / $10,471.29
| Facility | | $4,073.80 | $5,370.32 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $1,445.44 / $8,912.51
| Facility | | $602.56 | $1,445.44 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,202.26 / $1,202.26 / $1,202.26
| Facility | AS | $1,202.26 | $1,202.26 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,380.38 / $1,905.46
| Professional | | $1,348.96 | $1,380.38 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $6,606.93 / $8,912.51
| Facility | | $4,677.35 | $6,606.93 | $8,912.51 |