- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $7,943.28 / $16,595.87
| Facility | | $309.03 | $7,943.28 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $2,238.72 / $3,630.78
| Facility | | $1,548.82 | $2,238.72 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $457.09 / $891.25
| Facility | | $457.09 | $457.09 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $45.71 / $45.71 / $45.71
| Facility | AS | $45.71 | $45.71 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $512.86 / $616.60
| Professional | | $512.86 | $512.86 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.04 / $371.54 / $616.60
| Facility | | $257.04 | $371.54 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $6,760.83 / $9,120.11
| Facility | | $1,479.11 | $6,760.83 | $9,120.11 |