- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,796.03 / $9,147.12 / $29,101.79
| Facility | | $2,796.03 | $9,147.12 | $29,101.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,127.30 / $1,709.50 / $4,063.37
| Professional | | $1,127.30 | $1,709.50 | $4,063.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,553.37 / $3,270.29 / $23,351.66
| Facility | | $1,553.37 | $3,270.29 | $23,351.66 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $2,632.21 / $2,632.21 / $2,632.21
| Facility | AS | $2,632.21 | $2,632.21 | $2,632.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,104.00 / $3,622.02 / $8,854.25
| Facility | | $2,104.00 | $3,622.02 | $8,854.25 |
- 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 |