- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,491.26 / $4,014.00 / $7,119.04
| Facility | | $2,491.26 | $4,014.00 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $761.21 / $1,162.48 / $2,249.67
| Professional | | $761.21 | $1,162.48 | $2,249.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,131.14 / $2,019.23 / $14,242.22
| Facility | | $1,131.14 | $2,019.23 | $14,242.22 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $2,411.58 / $2,411.58 / $2,411.58
| Facility | AS | $2,411.58 | $2,411.58 | $2,411.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,279.00 / $2,052.44 / $8,463.62
| Facility | | $1,279.00 | $2,052.44 | $8,463.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,220.00 / $9,259.00 / $14,242.22
| Facility | | $8,220.00 | $9,259.00 | $14,242.22 |