- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $7,943.28 / $13,489.63
| Facility | | $1,819.70 | $7,943.28 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,128.31 / $10,232.93 / $20,417.38
| Facility | | $8,128.31 | $10,232.93 | $20,417.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $2,089.30 / $8,912.51
| Facility | | $851.14 | $2,089.30 | $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
- $2,041.74 / $2,089.30 / $2,884.03
| Professional | | $2,041.74 | $2,089.30 | $2,884.03 |
- 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 |