- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $7,943.28 / $16,595.87
| Facility | | $2,691.53 | $7,943.28 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $891.25 / $3,981.07
| Facility | | $891.25 | $891.25 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $398.11 / $398.11 / $398.11
| Facility | AS | $398.11 | $398.11 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,715.35 / $3,715.35 / $5,370.32
| Professional | | $3,715.35 | $3,715.35 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $3,019.95 / $5,128.61
| Facility | | $2,238.72 | $3,019.95 | $5,128.61 |
- 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 |