- 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
- $681.68 / $1,162.72 / $2,317.21
| Professional | | $681.68 | $1,162.72 | $2,317.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,112.01 / $1,806.01 / $14,242.22
| Facility | | $1,112.01 | $1,806.01 | $14,242.22 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $2,579.65 / $2,579.65 / $2,579.65
| Facility | AS | $2,579.65 | $2,579.65 | $2,579.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,352.84 / $1,806.01 / $9,158.41
| Facility | | $1,352.84 | $1,806.01 | $9,158.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,234.00 / $10,188.00 / $14,287.46
| Facility | | $7,234.00 | $10,188.00 | $14,287.46 |