- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,262.78 / $4,889.39 / $7,120.36
| Facility | | $2,262.78 | $4,889.39 | $7,120.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $735.27 / $1,159.59 / $1,439.51
| Professional | | $735.27 | $1,159.59 | $1,439.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,190.94 / $2,317.78 / $14,428.30
| Facility | | $1,190.94 | $2,317.78 | $14,428.30 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,618.01 / $1,618.01 / $1,618.01
| Facility | AS | $1,618.01 | $1,618.01 | $1,618.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,223.16 / $2,346.39 / $5,661.05
| Facility | | $1,223.16 | $2,346.39 | $5,661.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,220.00 / $9,346.00 / $14,242.22
| Facility | | $8,220.00 | $9,346.00 | $14,242.22 |