- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,091.00 / $7,090.00 / $11,611.47
| Facility | | $5,091.00 | $7,090.00 | $11,611.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $757.22 / $1,198.44 / $2,812.43
| Professional | | $757.22 | $1,198.44 | $2,812.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.32 / $2,047.48 / $7,896.02
| Facility | | $1,258.32 | $2,047.48 | $7,896.02 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,097.25 / $1,097.25 / $1,097.25
| Facility | AS | $1,097.25 | $1,097.25 | $1,097.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,550.75 / $2,117.16 / $3,919.79
| Facility | | $1,550.75 | $2,117.16 | $3,919.79 |
- 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 |