- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $6,606.93 / $8,128.31
| Facility | | $1,318.26 | $6,606.93 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $1,148.15 / $2,951.21
| Professional | | $724.44 | $1,148.15 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $2,137.96 / $9,549.93
| Facility | | $1,258.93 | $2,137.96 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,096.48 / $1,096.48 / $1,096.48
| Facility | AS | $1,096.48 | $1,096.48 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,621.81 / $1,949.84 / $2,290.87
| Professional | | $1,621.81 | $1,949.84 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,786.30 / $7,585.78 / $10,232.93
| Facility | | $4,786.30 | $7,585.78 | $10,232.93 |