- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,128.70 / $3,666.78 / $7,119.04
| Facility | | $1,128.70 | $3,666.78 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $886.39 / $1,320.03 / $2,612.21
| Professional | | $886.39 | $1,320.03 | $2,612.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $945.35 / $2,405.58 / $15,943.93
| Facility | | $945.35 | $2,405.58 | $15,943.93 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $2,454.02 / $2,454.02 / $2,454.02
| Facility | AS | $2,454.02 | $2,454.02 | $2,454.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,638.85 / $2,743.70 / $8,929.65
| Facility | | $1,638.85 | $2,743.70 | $8,929.65 |
- 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 |