- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,012.00 / $6,298.62 / $10,255.42
| Facility | | $5,012.00 | $6,298.62 | $10,255.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $780.05 / $1,261.94 / $4,568.83
| Professional | | $780.05 | $1,261.94 | $4,568.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,154.88 / $2,008.36 / $35,056.92
| Facility | | $1,154.88 | $2,008.36 | $35,056.92 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $9,733.53 / $9,733.53 / $9,733.53
| Facility | AS | $9,733.53 | $9,733.53 | $9,733.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,486.66 / $2,216.03 / $35,056.92
| Facility | | $1,486.66 | $2,216.03 | $35,056.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,542.00 / $12,871.00 / $16,293.00
| Facility | | $9,542.00 | $12,871.00 | $16,293.00 |