- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,850.50 / $4,032.12 / $7,119.04
| Facility | | $1,850.50 | $4,032.12 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $673.41 / $1,137.09 / $2,686.63
| Professional | | $673.41 | $1,137.09 | $2,686.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,136.95 / $1,779.11 / $12,342.67
| Facility | | $1,136.95 | $1,779.11 | $12,342.67 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $2,387.48 / $2,387.48 / $2,387.48
| Facility | AS | $2,387.48 | $2,387.48 | $2,387.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,321.00 / $1,779.11 / $8,332.41
| Facility | | $1,321.00 | $1,779.11 | $8,332.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,221.00 / $8,060.00 / $11,869.99
| Facility | | $7,221.00 | $8,060.00 | $11,869.99 |