- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $5,011.87 / $7,943.28
| Facility | | $1,071.52 | $5,011.87 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $977.24 / $2,398.83
| Professional | | $630.96 | $977.24 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,819.70 / $31,622.78
| Facility | | $1,071.52 | $1,819.70 | $31,622.78 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $5,128.61 / $5,128.61 / $5,128.61
| Facility | AS | $5,128.61 | $5,128.61 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $1,584.89 / $1,862.09
| Professional | | $1,380.38 | $1,584.89 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,471.29 / $16,218.10 / $34,673.69
| Facility | | $10,471.29 | $16,218.10 | $34,673.69 |