- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $4,168.69 / $11,748.98
| Facility | | $1,023.29 | $4,168.69 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $21,379.62 / $21,379.62 / $21,379.62
| Facility | AS | $21,379.62 | $21,379.62 | $21,379.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,128.31 / $10,471.29 / $16,595.87
| Facility | | $8,128.31 | $10,471.29 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,760.83 / $6,760.83 / $6,760.83
| Facility | | $6,760.83 | $6,760.83 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $1,258.93 / $3,715.35
| Professional | | $794.33 | $1,258.93 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $6,025.60 / $12,302.69
| Facility | | $2,137.96 | $6,025.60 | $12,302.69 |