- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,527.17 / $4,889.39 / $7,120.36
| Facility | | $2,527.17 | $4,889.39 | $7,120.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $755.39 / $1,195.58 / $2,652.21
| Professional | | $755.39 | $1,195.58 | $2,652.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,215.54 / $2,048.35 / $11,139.12
| Facility | | $1,215.54 | $2,048.35 | $11,139.12 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,887.52 / $1,887.52 / $1,887.52
| Facility | AS | $1,887.52 | $1,887.52 | $1,887.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,459.00 / $2,059.38 / $6,616.19
| Facility | | $1,459.00 | $2,059.38 | $6,616.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,341.00 / $6,588.00 / $10,320.00
| Facility | | $5,341.00 | $6,588.00 | $10,320.00 |