- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,365.22 / $5,463.36 / $11,266.60
| Facility | | $3,365.22 | $5,463.36 | $11,266.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $683.06 / $1,575.26 / $2,858.96
| Professional | | $683.06 | $1,575.26 | $2,858.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $995.05 / $2,658.74 / $20,063.05
| Facility | | $995.05 | $2,658.74 | $20,063.05 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $4,526.82 / $4,526.82 / $4,526.82
| Facility | AS | $4,526.82 | $4,526.82 | $4,526.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,306.83 / $2,777.31 / $15,963.93
| Facility | | $1,306.83 | $2,777.31 | $15,963.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,341.00 / $6,588.00 / $10,320.00
| Facility | | $5,341.00 | $6,588.00 | $10,320.00 |