- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $4,570.88 / $7,413.10
| Facility | | $1,202.26 | $4,570.88 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $2,238.72 / $4,786.30
| Facility | | $954.99 | $2,238.72 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $1,258.93 / $1,318.26
| Facility | | $851.14 | $1,258.93 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $131.83 / $131.83 / $131.83
| Facility | AS | $131.83 | $131.83 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $1,122.02 / $4,168.69
| Professional | | $812.83 | $1,122.02 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $35.48 / $35.48 / $35.48
| Professional | AS | $35.48 | $35.48 | $35.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $4,168.69 / $6,918.31
| Facility | | $1,122.02 | $4,168.69 | $6,918.31 |