- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,218.00 / $3,576.15 / $7,119.04
| Facility | | $2,218.00 | $3,576.15 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $700.62 / $1,332.90 / $2,368.96
| Professional | | $700.62 | $1,332.90 | $2,368.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,576.84 / $2,091.40 / $45,147.00
| Facility | | $1,576.84 | $2,091.40 | $45,147.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $9,295.29 / $9,295.29 / $9,295.29
| Facility | AS | $9,295.29 | $9,295.29 | $9,295.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,408.67 / $2,308.53 / $32,625.72
| Facility | | $1,408.67 | $2,308.53 | $32,625.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,780.00 / $13,193.00 / $19,114.00
| Facility | | $9,780.00 | $13,193.00 | $19,114.00 |