- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,308.17 / $4,731.57 / $12,765.09
| Facility | | $2,308.17 | $4,731.57 | $12,765.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $834.81 / $1,244.78 / $2,782.04
| Professional | | $834.81 | $1,244.78 | $2,782.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,043.41 / $2,313.11 / $75,868.70
| Facility | | $1,043.41 | $2,313.11 | $75,868.70 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $13,888.08 / $13,888.08 / $13,888.08
| Facility | AS | $13,888.08 | $13,888.08 | $13,888.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.44 / $2,674.87 / $51,664.54
| Facility | | $1,548.44 | $2,674.87 | $51,664.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,855.00 / $16,742.00 / $21,923.00
| Facility | | $12,855.00 | $16,742.00 | $21,923.00 |