- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,448.25 / $3,666.78 / $7,119.04
| Facility | | $1,448.25 | $3,666.78 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $356.83 / $571.89 / $2,669.47
| Professional | | $356.83 | $571.89 | $2,669.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $539.95 / $1,007.40 / $32,716.41
| Facility | | $539.95 | $1,007.40 | $32,716.41 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $7,800.40 / $7,800.40 / $7,800.40
| Facility | AS | $7,800.40 | $7,800.40 | $7,800.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $771.00 / $1,025.48 / $27,367.26
| Facility | | $771.00 | $1,025.48 | $27,367.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,855.00 / $16,742.00 / $40,166.00
| Facility | | $12,855.00 | $16,742.00 | $40,166.00 |