- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,146.00 / $5,091.00 / $7,120.36
| Facility | | $4,146.00 | $5,091.00 | $7,120.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,091.42 / $1,672.11 / $4,268.29
| Professional | | $1,091.42 | $1,672.11 | $4,268.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,579.08 / $2,884.26 / $11,139.12
| Facility | | $1,579.08 | $2,884.26 | $11,139.12 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,887.52 / $1,887.52 / $1,887.52
| Facility | AS | $1,887.52 | $1,887.52 | $1,887.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,172.06 / $3,114.47 / $6,616.19
| Facility | | $2,172.06 | $3,114.47 | $6,616.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,341.00 / $6,588.00 / $10,320.00
| Facility | | $5,341.00 | $6,588.00 | $10,320.00 |