- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $4,786.30 / $7,079.46
| Facility | | $1,096.48 | $4,786.30 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $954.99 / $2,187.76
| Professional | | $645.65 | $954.99 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,819.70 / $31,622.78
| Facility | | $1,096.48 | $1,819.70 | $31,622.78 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $5,128.61 / $5,128.61 / $5,128.61
| Facility | AS | $5,128.61 | $5,128.61 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,412.54 / $1,584.89 / $1,862.09
| Professional | | $1,412.54 | $1,584.89 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,511.38 / $13,489.63 / $34,673.69
| Facility | | $8,511.38 | $13,489.63 | $34,673.69 |