- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,146.00 / $5,091.00 / $10,563.53
| Facility | | $4,146.00 | $5,091.00 | $10,563.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $744.26 / $1,142.09 / $2,397.98
| Professional | | $744.26 | $1,142.09 | $2,397.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,119.89 / $1,938.93 / $20,063.05
| Facility | | $1,119.89 | $1,938.93 | $20,063.05 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $5,343.73 / $5,343.73 / $5,343.73
| Facility | AS | $5,343.73 | $5,343.73 | $5,343.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.36 / $1,926.25 / $18,503.16
| Facility | | $1,445.36 | $1,926.25 | $18,503.16 |
- 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 |