- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $3,981.07 / $9,120.11
| Facility | | $1,202.26 | $3,981.07 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,479.11 / $2,570.40
| Professional | | $851.14 | $1,479.11 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $16,218.10 / $81,283.05
| Facility | | $1,202.26 | $16,218.10 | $81,283.05 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $14,125.38 / $14,125.38 / $14,125.38
| Facility | AS | $14,125.38 | $14,125.38 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,412.54 / $1,995.26 / $2,398.83
| Professional | | $1,412.54 | $1,995.26 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,218.10 / $25,703.96 / $81,283.05
| Facility | | $16,218.10 | $25,703.96 | $81,283.05 |