- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $4,466.84 / $7,413.10
| Facility | | $977.24 | $4,466.84 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $5,128.61 / $14,791.08
| Facility | | $1,202.26 | $5,128.61 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $660.69 / $851.14
| Facility | | $660.69 | $660.69 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $66.07 / $66.07 / $66.07
| Facility | AS | $66.07 | $66.07 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $602.56 / $2,137.96
| Professional | | $416.87 | $602.56 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $17.78 / $17.78 / $17.78
| Professional | AS | $17.78 | $17.78 | $17.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $12,022.64 / $38,018.94
| Facility | | $2,630.27 | $12,022.64 | $38,018.94 |