- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,218.00 / $3,758.06 / $7,119.04
| Facility | | $2,218.00 | $3,758.06 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $571.76 / $908.22 / $1,946.16
| Professional | | $571.76 | $908.22 | $1,946.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $847.51 / $1,532.22 / $11,139.12
| Facility | | $847.51 | $1,532.22 | $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
- $1,101.00 / $1,538.45 / $6,616.19
| Facility | | $1,101.00 | $1,538.45 | $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 |