- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,833.00 / $4,235.59 / $7,119.04
| Facility | | $2,833.00 | $4,235.59 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $577.55 / $903.63 / $2,301.32
| Professional | | $577.55 | $903.63 | $2,301.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.22 / $1,527.55 / $11,139.12
| Facility | | $977.22 | $1,527.55 | $11,139.12 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,887.52 / $1,887.52 / $1,887.52
| Facility | AS | $1,887.52 | $1,887.52 | $1,887.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,141.01 / $1,522.54 / $6,616.19
| Facility | | $1,141.01 | $1,522.54 | $6,616.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,341.00 / $9,495.24 / $18,346.22
| Facility | | $5,341.00 | $9,495.24 | $18,346.22 |