- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $6,165.95 / $19,952.62
| Facility | | $1,318.26 | $6,165.95 | $19,952.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,513.56 / $2,187.76 / $7,413.10
| Professional | | $1,513.56 | $2,187.76 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $4,365.16 / $45,708.82
| Facility | | $1,949.84 | $4,365.16 | $45,708.82 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $7,585.78 / $7,585.78 / $7,585.78
| Facility | AS | $7,585.78 | $7,585.78 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,311.31 / $3,630.78 / $4,365.16
| Professional | | $3,311.31 | $3,630.78 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,511.38 / $13,489.63 / $46,773.51
| Facility | | $8,511.38 | $13,489.63 | $46,773.51 |