- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $5,370.32 / $9,549.93
| Facility | | $1,230.27 | $5,370.32 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $3,548.13 / $7,079.46
| Facility | | $1,230.27 | $3,548.13 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $1,621.81 / $2,511.89
| Facility | | $501.19 | $1,621.81 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $162.18 / $162.18 / $162.18
| Facility | AS | $162.18 | $162.18 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,548.82 / $5,128.61
| Professional | | $1,071.52 | $1,548.82 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $44.67 / $44.67 / $44.67
| Professional | AS | $44.67 | $44.67 | $44.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $3,235.94 / $7,943.28
| Facility | | $630.96 | $3,235.94 | $7,943.28 |