- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,496.00 / $4,917.20 / $7,119.04
| Facility | | $3,496.00 | $4,917.20 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $762.08 / $1,210.97 / $3,034.88
| Professional | | $762.08 | $1,210.97 | $3,034.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,269.04 / $2,117.28 / $12,342.67
| Facility | | $1,269.04 | $2,117.28 | $12,342.67 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $2,537.14 / $2,537.14 / $2,537.14
| Facility | AS | $2,537.14 | $2,537.14 | $2,537.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.16 / $2,135.06 / $8,817.39
| Facility | | $1,479.16 | $2,135.06 | $8,817.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,221.00 / $8,060.00 / $11,869.99
| Facility | | $7,221.00 | $8,060.00 | $11,869.99 |