- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $7,943.28 / $16,595.87
| Facility | | $2,454.71 | $7,943.28 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $14,791.08 / $15,488.17
| Facility | | $2,344.23 | $14,791.08 | $15,488.17 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $363.08 / $363.08 / $363.08
| Facility | AS | $363.08 | $363.08 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,467.37 / $3,467.37 / $4,897.79
| Professional | | $3,467.37 | $3,467.37 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $2,754.23 / $4,677.35
| Facility | | $2,041.74 | $2,754.23 | $4,677.35 |
- 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 |