- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,906.97 / $5,463.36 / $10,506.16
| Facility | | $3,906.97 | $5,463.36 | $10,506.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $646.03 / $1,100.11 / $1,835.35
| Professional | | $646.03 | $1,100.11 | $1,835.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $966.81 / $1,845.34 / $16,586.06
| Facility | | $966.81 | $1,845.34 | $16,586.06 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,678.13 / $1,678.13 / $1,678.13
| Facility | AS | $1,678.13 | $1,678.13 | $1,678.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.00 / $2,072.89 / $6,156.40
| Facility | | $1,174.00 | $2,072.89 | $6,156.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,221.00 / $8,523.00 / $11,869.99
| Facility | | $7,221.00 | $8,523.00 | $11,869.99 |