- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $3,981.07 / $7,413.10
| Facility | | $1,071.52 | $3,981.07 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $954.99 / $2,691.53
| Professional | | $645.65 | $954.99 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $1,778.28 / $9,772.37
| Facility | | $977.24 | $1,778.28 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $851.14 / $851.14 / $851.14
| Facility | AS | $851.14 | $851.14 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $1,548.82 / $1,819.70
| Professional | | $1,380.38 | $1,548.82 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,128.61 / $9,120.11 / $14,125.38
| Facility | | $5,128.61 | $9,120.11 | $14,125.38 |