- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $3,235.94 / $6,760.83
| Facility | | $1,445.44 | $3,235.94 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,318.26 / $3,801.89
| Professional | | $831.76 | $1,318.26 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $2,089.30 / $9,772.37
| Facility | | $1,148.15 | $2,089.30 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $436.52 / $436.52 / $436.52
| Facility | AS | $436.52 | $436.52 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,737.80 / $2,089.30 / $2,511.89
| Professional | | $1,737.80 | $2,089.30 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,128.61 / $9,120.11 / $14,125.38
| Facility | | $5,128.61 | $9,120.11 | $14,125.38 |