- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $5,248.07 / $7,943.28
| Facility | | $1,778.28 | $5,248.07 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,621.81 / $3,801.89
| Professional | | $1,047.13 | $1,621.81 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $2,570.40 / $9,772.37
| Facility | | $1,445.44 | $2,570.40 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $524.81 / $524.81 / $524.81
| Facility | AS | $524.81 | $524.81 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,290.87 / $2,570.40 / $3,019.95
| Professional | | $2,290.87 | $2,570.40 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,511.38 / $11,748.98 / $19,498.45
| Facility | | $8,511.38 | $11,748.98 | $19,498.45 |