- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,348.96 / $22,908.68
| Professional | | $1,071.52 | $1,348.96 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $6,606.93 / $21,379.62
| Facility | | $676.08 | $6,606.93 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,709.64 / $18,197.01 / $58,884.37
| Professional | | $8,709.64 | $18,197.01 | $58,884.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,174.90 / $23,988.33
| Professional | | $1,096.48 | $1,174.90 | $23,988.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $12,022.64 / $15,135.61
| Professional | | $831.76 | $12,022.64 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $3,981.07 / $3,981.07 / $3,981.07
| Professional | AS | $3,981.07 | $3,981.07 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $1,412.54 / $27,542.29
| Professional | | $630.96 | $1,412.54 | $27,542.29 |