- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,194.72 / $3,716.28 / $7,119.04
| Facility | | $1,194.72 | $3,716.28 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $609.67 / $1,030.41 / $2,519.80
| Professional | | $609.67 | $1,030.41 | $2,519.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,016.62 / $1,631.98 / $11,139.12
| Facility | | $1,016.62 | $1,631.98 | $11,139.12 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $2,462.39 / $2,462.39 / $2,462.39
| Facility | AS | $2,462.39 | $2,462.39 | $2,462.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,186.59 / $1,581.97 / $8,443.70
| Facility | | $1,186.59 | $1,581.97 | $8,443.70 |
- 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 |