- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $4,570.88 / $7,413.10
| Facility | | $2,511.89 | $4,570.88 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $2,238.72 / $4,786.30
| Facility | | $691.83 | $2,238.72 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $1,548.82 / $2,187.76
| Facility | | $512.86 | $1,548.82 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $1,071.52 / $2,951.21
| Professional | | $812.83 | $1,071.52 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $30.20 / $30.20 / $38.90
| Professional | AS | $30.20 | $30.20 | $38.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $4,677.35 / $8,511.38
| Facility | | $660.69 | $4,677.35 | $8,511.38 |