- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,906.00 / $4,235.59 / $7,119.04
| Facility | | $2,906.00 | $4,235.59 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $433.53 / $620.96 / $1,829.11
| Professional | | $433.53 | $620.96 | $1,829.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $652.25 / $1,082.45 / $23,817.66
| Facility | | $652.25 | $1,082.45 | $23,817.66 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $5,848.03 / $5,848.03 / $5,848.03
| Facility | AS | $5,848.03 | $5,848.03 | $5,848.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $946.87 / $1,152.17 / $21,755.06
| Facility | | $946.87 | $1,152.17 | $21,755.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,220.00 / $9,259.00 / $14,242.22
| Facility | | $8,220.00 | $9,259.00 | $14,242.22 |